Basic Information
| Provider Information | |||||||||
| NPI: | 1306849369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEMME | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017258347 | ||||||||
| FaxNumber: | 9012597637 | ||||||||
| Practice Location | |||||||||
| Address1: | 6286 BRIARCREST AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381204023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016413000 | ||||||||
| FaxNumber: | 9012591698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3538 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 110318002 | 05 | AR | MEDICAID | 157409721 | 05 | AR | MEDICAID | 3645235 | 05 | TN | MEDICAID | 620819926 | 01 | TN | AETNA | OTHER | 3112381 | 01 | TN | BCBS | OTHER | 620819926 | 01 | TN | CIGNA | OTHER | 620819926 | 01 | TN | TRICARE | OTHER | 7187860 | 05 | MS | MEDICAID | P00341095 | 01 | TN | RAILROAD MEDICARE | OTHER | 5599758 | 01 | TN | AETNA | OTHER | 03773399 | 05 | MS | MEDICAID | 3371161 | 05 | TN | MEDICAID | 620819926 | 01 | MS | BCBS | OTHER |