Individual
MARY KATHLEEN GRAVATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1750 LINDA LN, MARYVILLE, TN 37803
(865) 200-3093
Mailing address
1750 LINDA LN, MARYVILLE, TN 37803-5536
(865) 200-3093
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5424
TN
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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