Provider Demographics
NPI:1164975702
Name:MAX POTENTIAL FARRAGUT, LLC
Entity Type:Organization
Organization Name:MAX POTENTIAL FARRAGUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-392-6001
Mailing Address - Street 1:11201 W POINT DR
Mailing Address - Street 2:STE 104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2833
Mailing Address - Country:US
Mailing Address - Phone:865-392-6001
Mailing Address - Fax:865-392-6003
Practice Address - Street 1:11201 W POINT DR
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2833
Practice Address - Country:US
Practice Address - Phone:865-392-6001
Practice Address - Fax:865-392-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty