Provider Demographics
NPI:1255690285
Name:DIEGEL, CHARLES A (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:DIEGEL
Suffix:
Gender:M
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR STE 100A
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-988-8796
Practice Address - Fax:865-988-8798
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528678Medicaid
TN0677340010Medicare NSC
TN0677340001Medicare NSC
TN0677340005Medicare NSC
TN0677340003Medicare NSC
TN10365I3673Medicare PIN
TN0677340004Medicare NSC