Provider Demographics
NPI:1114742830
Name:HOUNSLOW, MARCELLE MARGARET (PT)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:MARGARET
Last Name:HOUNSLOW
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 1:139 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-7430
Mailing Address - Country:US
Mailing Address - Phone:980-475-0837
Mailing Address - Fax:
Practice Address - Street 1:4850 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-2145
Practice Address - Country:US
Practice Address - Phone:980-475-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16130208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation