Provider Demographics
NPI:1023274339
Name:BADER, MARY CRISTINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CRISTINE
Last Name:BADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N GERMANTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6215
Mailing Address - Country:US
Mailing Address - Phone:901-752-5998
Mailing Address - Fax:901-751-9799
Practice Address - Street 1:955 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6215
Practice Address - Country:US
Practice Address - Phone:901-752-5998
Practice Address - Fax:901-751-9799
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2590225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant