Provider Demographics
NPI:1366480600
Name:ROBBINS, CHANNON LEIGH (PT)
Entity Type:Individual
Prefix:
First Name:CHANNON
Middle Name:LEIGH
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHANNON
Other - Middle Name:LEIGH
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1608 GUNBARREL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7197
Practice Address - Country:US
Practice Address - Phone:423-892-8070
Practice Address - Fax:423-893-9891
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST - GROUP NUMBER
TN446652Medicare ID - Type UnspecifiedGROUP NUMBER