Provider Demographics
NPI:1750971354
Name:MEKHAIL, SUSANNA MAHER ESHAAK
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:MAHER ESHAAK
Last Name:MEKHAIL
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 1:2104 OAKSPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0905
Mailing Address - Country:US
Mailing Address - Phone:615-627-8781
Mailing Address - Fax:
Practice Address - Street 1:2009 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3913
Practice Address - Country:US
Practice Address - Phone:615-384-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty