Healthcare Provider Details

I. General information

NPI: 1962687061
Provider Name (Legal Business Name): SUSAN MICHELLE GUINN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-3098
US

IV. Provider business mailing address

4850 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-3098
US

V. Phone/Fax

Practice location:
  • Phone: 423-787-6800
  • Fax:
Mailing address:
  • Phone: 423-787-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4141
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: