Provider Demographics
NPI:1306849369
Name:TEMME, MARK PAUL (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PAUL
Last Name:TEMME
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-259-1698
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110318002Medicaid
AR157409721Medicaid
TN3645235Medicaid
TN620819926OtherAETNA
TN3112381OtherBCBS
TN620819926OtherCIGNA
TN620819926OtherTRICARE
MS7187860Medicaid
TNP00341095OtherRAILROAD MEDICARE
TN5599758OtherAETNA
MS03773399Medicaid
TN3371161Medicaid
MS620819926OtherBCBS
TN3645235Medicaid
AR110318002Medicaid