Provider Demographics
NPI:1952131500
Name:PRINE, MARY GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:PRINE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1737
Mailing Address - Country:US
Mailing Address - Phone:731-418-8100
Mailing Address - Fax:
Practice Address - Street 1:529 HIGH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1737
Practice Address - Country:US
Practice Address - Phone:731-418-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41685225100000X
TN16248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist