Provider Demographics
NPI:1437335130
Name:GRAVES, MARY KAY KATHRYN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:KATHRYN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 LYNNWOOD TER
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2914
Mailing Address - Country:US
Mailing Address - Phone:615-269-3437
Mailing Address - Fax:615-269-3524
Practice Address - Street 1:1500 22ND AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205
Practice Address - Country:US
Practice Address - Phone:615-322-4751
Practice Address - Fax:615-322-7671
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist