MEDICARE: SUSANNA MAHER ESHAAK MEKHAIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	6148	TN

General Provider Information

NPI Number	:	1750971354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA MAHER ESHAAK MEKHAIL

Provider Business Mailing Address
First Line	:	2104 OAKSPRINGS PL
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-0905
Country	:	US
Telephone Number	:	615-627-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3913
Country	:	US
Telephone Number	:	615-384-3836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	01/19/2021

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