Mary Grace Distretti, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9655 Issued in TN

Practice address

5220 Park Ave Ste 201
Memphis, TN 38119-3549

Phone

(901) 683-9630

Fax

(901) 767-2663

NPI assigned

Jun 13, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Grace Yeager Former name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agilitas USA Inc

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  Physical Therapist

  Medicare reassignment NPD
• Agilitas USA, Inc

  • Physical Therapy Clinic/Center
  • Chattanooga, TN
  • NPI 1518695436

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1215375126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306393",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306393",
            "telephone_number": "615-373-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 PARK AVE STE 201",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193549",
            "telephone_number": "901-683-9630",
            "fax_number": "901-767-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTRETTI",
        "first_name": "MARY",
        "middle_name": "GRACE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-13",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "9655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1336494103",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "YEAGER",
            "middle_name": "GRACE",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dishman House
• Brooke Erin Dishmon, D.D.S.
• Dwight Anthony Dishmon, MD
• Christopher James Distin
• Amy Distretti, NNP
• Lauren C Ditta, M.D.
• Diversified Healthcare
• Divine Caring Home Health Inc
• Divine Intervention Home Care Agency LLC
• Divine Intervention Transportation Services PLLC

• Physical Therapist in Memphis, TN
• Providers in Memphis, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.