Provider Demographics
NPI:1073737417
Name:MAHINAY, BLISS BARBY L (PT)
Entity Type:Individual
Prefix:MRS
First Name:BLISS BARBY
Middle Name:L
Last Name:MAHINAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 TRAIL HILL CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6679
Mailing Address - Country:US
Mailing Address - Phone:901-737-0545
Mailing Address - Fax:
Practice Address - Street 1:2805 CHARLES BRYAN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4756
Practice Address - Country:US
Practice Address - Phone:901-386-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003626313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility