Individual
MARY GRACE DISTRETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5220 PARK AVE STE 201, MEMPHIS, TN 38119-3549
(901) 683-9630
(901) 767-2663
Mailing address
PO BOX 306393, NASHVILLE, TN 37230-6393
(615) 373-1350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9655
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336494103
GROUP NPI
TN
Enumeration date
06/13/2013
Last updated
02/08/2022
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