Provider Demographics
NPI:1821117425
Name:MAYNARD, LOUISA SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:SUZANNE
Last Name:MAYNARD
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-284-7055
Mailing Address - Fax:615-284-7070
Practice Address - Street 1:1000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3420
Practice Address - Country:US
Practice Address - Phone:615-284-7055
Practice Address - Fax:615-284-7070
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist