Provider Demographics
NPI:1518043751
Name:ORTHOTENNESSEE, PC
Entity Type:Organization
Organization Name:ORTHOTENNESSEE, PC
Other - Org Name:ORTHOTENNESSEE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-769-4545
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:7557 DANNAHER LN
Practice Address - Street 2:SUITE G30
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3558
Practice Address - Country:US
Practice Address - Phone:865-512-1140
Practice Address - Fax:865-512-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711622Medicare UPIN