Individual
PETRA GODEFRIEDA MYSIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1535 VANN DR, JACKSON, TN 38305-2095
(731) 984-9962
(731) 984-9941
Mailing address
1535 VANN DR, JACKSON, TN 38305-2095
(731) 984-9962
(731) 984-9941
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2244
TN
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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