Provider Demographics
NPI:1518114917
Name:SEPULVEDA, MARIA S (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:S
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 AMOHI WAY
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-3008
Mailing Address - Country:US
Mailing Address - Phone:865-458-1598
Mailing Address - Fax:
Practice Address - Street 1:1520 GROVE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1575
Practice Address - Country:US
Practice Address - Phone:865-452-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT3432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist