Provider Demographics
NPI:1154674216
Name:CARSON, MARY LESLIE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LESLIE
Last Name:CARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:BUICE
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:275 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3325
Mailing Address - Country:US
Mailing Address - Phone:615-231-5111
Mailing Address - Fax:615-231-5072
Practice Address - Street 1:275 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3325
Practice Address - Country:US
Practice Address - Phone:615-231-5111
Practice Address - Fax:615-231-5072
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist