Provider Demographics
NPI:1295125920
Name:NUESSEN-LANDRY, SARAH MARIE (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:NUESSEN-LANDRY
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:900 E JACKSON BLVD
Practice Address - Street 2:STE 4
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1505
Practice Address - Country:US
Practice Address - Phone:423-218-1751
Practice Address - Fax:423-218-1752
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist