1689917379 NPI number — MARGARET PHILLPS GREATHOUSE PT

Table of content: MARGARET PHILLPS GREATHOUSE PT (NPI 1689917379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689917379 NPI number — MARGARET PHILLPS GREATHOUSE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREATHOUSE
Provider First Name:
MARGARET
Provider Middle Name:
PHILLPS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRETT
Provider Other First Name:
MARGARET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689917379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37230-6393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004 HAYES ST
Provider Second Line Business Practice Location Address:
SUITE 545
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-284-7555
Provider Business Practice Location Address Fax Number:
615-284-7075
Provider Enumeration Date:
04/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1042 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000001042 . This is a "PHYSICAL THERAPY LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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