Provider Demographics
NPI:1841928173
Name:GREGORY, MACIE SUZANNE
Entity type:Individual
Prefix:
First Name:MACIE
Middle Name:SUZANNE
Last Name:GREGORY
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 1:10818 VALLEY CROSSING WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1876
Mailing Address - Country:US
Mailing Address - Phone:865-659-1338
Mailing Address - Fax:
Practice Address - Street 1:300 BRIARCLIFF AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8731
Practice Address - Country:US
Practice Address - Phone:865-481-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant