MEDICARE: MARCIA JEFFERSON PT

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	174400000X	Specialist	2251X0800X	TN

General Provider Information

NPI Number	:	1942542238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA JEFFERSON PT

Provider Business Mailing Address
First Line	:	3810 BEDFORD AVE
Second Line	:	SUITE 120
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2514
Country	:	US
Telephone Number	:	615-292-1253
Fax Number	:	615-292-8148

Provider Business Practice Location Address
First Line	:	3810 BEDFORD AVE
Second Line	:	SUITE 120
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2514
Country	:	US
Telephone Number	:	615-292-1253
Fax Number	:	615-292-8148

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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