Provider Demographics
NPI:1437635034
Name:TRISTAR PHYSICAL THERAPY AND CHIROPRACTIC
Entity Type:Organization
Organization Name:TRISTAR PHYSICAL THERAPY AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, DPT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-258-2264
Mailing Address - Street 1:2024 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5410
Mailing Address - Country:US
Mailing Address - Phone:423-317-7772
Mailing Address - Fax:
Practice Address - Street 1:2024 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5410
Practice Address - Country:US
Practice Address - Phone:423-317-7772
Practice Address - Fax:423-317-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11101261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027222Medicaid