Individual
ELIZABETH SUZANNE SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
344 HENSLEE DR, SUITE 8, DICKSON, TN 37055-2051
(615) 446-7623
(615) 446-7624
Mailing address
2001 MALLORY LN, SUITE 201, FRANKLIN, TN 37067-8233
(615) 373-1350
(615) 373-7116
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8290
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8290
TN STATE LICENSE
TN
Enumeration date
02/27/2009
Last updated
02/27/2009
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