Provider Demographics
NPI:1518192855
Name:ADDISON, ELIZABETH HYUN MCGUIRE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HYUN MCGUIRE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:HYUN
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2670 MCINGVALE RD STE J
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8696
Mailing Address - Country:US
Mailing Address - Phone:901-641-3000
Mailing Address - Fax:901-701-2428
Practice Address - Street 1:8040 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1773
Practice Address - Country:US
Practice Address - Phone:901-522-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8324225100000X
MSPT5199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist