Provider Demographics
NPI:1093906190
Name:KNOXVILLE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:KNOXVILLE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOUGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-637-2321
Mailing Address - Street 1:709 S CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3309
Mailing Address - Country:US
Mailing Address - Phone:865-637-2321
Mailing Address - Fax:
Practice Address - Street 1:709 S CONCORD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3309
Practice Address - Country:US
Practice Address - Phone:865-637-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715534Medicaid
TN3715534Medicaid