Provider Demographics
NPI:1194022798
Name:MACKENZIE, ADRIEN GREY (PTA, LMT, CLT-LANA)
Entity Type:Individual
Prefix:MS
First Name:ADRIEN
Middle Name:GREY
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:PTA, LMT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4407
Mailing Address - Country:US
Mailing Address - Phone:615-579-6629
Mailing Address - Fax:615-781-9547
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:SUITE 105
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-579-6629
Practice Address - Fax:615-781-9547
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4521225200000X
TN7130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant