Healthcare Provider Details

I. General information

NPI: 1699684159
Provider Name (Legal Business Name): EMILY LORENE MABRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 E MANNING ST APT 1
CHATTANOOGA TN
37405-4693
US

IV. Provider business mailing address

518 E MANNING ST APT 1
CHATTANOOGA TN
37405-4693
US

V. Phone/Fax

Practice location:
  • Phone: 423-414-4601
  • Fax:
Mailing address:
  • Phone: 423-414-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15390
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: