Provider Demographics
NPI:1508071978
Name:MCJUNKIN, DAVID RAIE (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RAIE
Last Name:MCJUNKIN
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 1:1655 MECCA PIKE
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385-0000
Mailing Address - Country:US
Mailing Address - Phone:423-253-6839
Mailing Address - Fax:
Practice Address - Street 1:8805 NEW HIGHWAY 68 UNIT 1
Practice Address - Street 2:
Practice Address - City:TELLICO PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37385-5347
Practice Address - Country:US
Practice Address - Phone:423-253-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist