Provider Demographics
NPI:1508277336
Name:RUSSELL, MEREDITH
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TAFT HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2774
Mailing Address - Country:US
Mailing Address - Phone:423-886-6979
Mailing Address - Fax:423-886-6962
Practice Address - Street 1:2001 MALLORY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8233
Practice Address - Country:US
Practice Address - Phone:615-373-1350
Practice Address - Fax:615-221-9054
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist