Provider Demographics
NPI:1376634667
Name:CLOWERS, KENNETH R (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:CLOWERS
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 1:9600 BUCKHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2071
Mailing Address - Country:US
Mailing Address - Phone:865-809-4927
Mailing Address - Fax:
Practice Address - Street 1:100 LETORY RD
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3224
Practice Address - Country:US
Practice Address - Phone:423-346-3220
Practice Address - Fax:423-346-3223
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0677340004Medicare NSC
TN0677340002Medicare NSC
TN0677340010Medicare NSC
TN0677340005Medicare NSC
TN3650051Medicaid
3650051Medicare PIN
TN0677340001Medicare NSC
TN0677340003Medicare NSC