Provider Demographics
NPI:1225355936
Name:PERALTA, JOHNNA JO (PT)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:JO
Last Name:PERALTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SW CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-7532
Mailing Address - Country:US
Mailing Address - Phone:865-379-5222
Mailing Address - Fax:
Practice Address - Street 1:1012 JAMESTOWN WAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-5865
Practice Address - Country:US
Practice Address - Phone:865-984-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist