Healthcare Provider Details

I. General information

NPI: 1043308117
Provider Name (Legal Business Name): KRISTIN MAZZEO GARNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 MALLORY LN SUITE 103
BRENTWOOD TN
37027-2909
US

IV. Provider business mailing address

2789 LAFAYETTE DR
THOMPSONS STATION TN
37179
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-5437
  • Fax: 615-309-8342
Mailing address:
  • Phone: 615-595-8423
  • Fax: 615-595-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6483
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number6483
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: