Provider Demographics
NPI:1487651089
Name:MICHALIK, JAMES P (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:MICHALIK
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 1:6700 BAUM DR
Mailing Address - Street 2:STE 19
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7334
Mailing Address - Country:US
Mailing Address - Phone:865-588-4108
Mailing Address - Fax:865-474-1521
Practice Address - Street 1:6700 BAUM DR
Practice Address - Street 2:STE 19
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7334
Practice Address - Country:US
Practice Address - Phone:865-588-4108
Practice Address - Fax:865-474-1521
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0166930001OtherDURABLE MED EQUIP MEDICAR
TN650008553OtherRAILROAD MEDICARE
TN3654677Medicaid
TN0025925OtherBLUE CROSS BLUE SHIELD
TNTN0101OtherJOHN DEERE
TN3654677Medicaid
3650443Medicare UPIN