Provider Demographics
NPI:1528019759
Name:CAWTHORN, MARY C (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:CAWTHORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CANTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 32709
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2709
Mailing Address - Country:US
Mailing Address - Phone:865-558-6484
Mailing Address - Fax:865-584-4037
Practice Address - Street 1:1904 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5402
Practice Address - Country:US
Practice Address - Phone:865-983-8129
Practice Address - Fax:865-983-8293
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3659214Medicaid
TN4086005OtherBLUE CROSS
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN3659214Medicaid