Provider Demographics
NPI:1023272754
Name:GESELL, MEGAN M (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:GESELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MOSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0200
Practice Address - Fax:615-885-0267
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8119225100000X
TNPT0000008119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100281950Medicaid
TN1513554Medicaid
TN4356028OtherBCBS OF TN
TN0446631Medicaid
TN0446631Medicaid
TN103I653186Medicare PIN