Provider Demographics
NPI:1235103763
Name:DUNCANSON, ROBERT W (MED, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:DUNCANSON
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15162
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5162
Mailing Address - Country:US
Mailing Address - Phone:865-974-1359
Mailing Address - Fax:865-974-1259
Practice Address - Street 1:1704 JOHNNY MAJORS DR
Practice Address - Street 2:RM. 117A, NEYLAND-THOMPSON SPORTS CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-4538
Practice Address - Country:US
Practice Address - Phone:865-974-1359
Practice Address - Fax:865-974-1259
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 1441174400000X
TN00000010732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174400000XOther Service ProvidersSpecialist