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Individual

MARIA ROSSANA S. DATUIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
616 W FOREST AVE, JACKSON, TN 38301-3902
(731) 422-0330
(731) 422-0220
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4194
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3652656
TN
Enumeration date
03/10/2006
Last updated
02/14/2012
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