Provider Demographics
NPI:1922767870
Name:GAYLORD, ANNA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 THORNDALE DR
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-6804
Mailing Address - Country:US
Mailing Address - Phone:731-514-3070
Mailing Address - Fax:
Practice Address - Street 1:14510 US-79
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist