Provider Demographics
NPI:1164559977
Name:CREASEY, JUSTIN EUGENE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:EUGENE
Last Name:CREASEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 SHERINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4836
Mailing Address - Country:US
Mailing Address - Phone:865-947-5848
Mailing Address - Fax:
Practice Address - Street 1:260 FORT SANDERS WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT 00000007242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer