Provider Demographics
NPI:1548253230
Name:SECREST, MARGARET R (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:SECREST
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 1:6219 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2979
Mailing Address - Country:US
Mailing Address - Phone:423-553-8175
Mailing Address - Fax:423-553-8177
Practice Address - Street 1:6219 VANCE RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2979
Practice Address - Country:US
Practice Address - Phone:423-553-8175
Practice Address - Fax:423-553-8177
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000002243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3157469OtherBCBS PROVIDER #
TN3653366Medicaid
TN621829028OtherTAX ID
TN3652092Medicare ID - Type UnspecifiedPROVIDER #
TN3653366Medicaid