Provider Demographics
NPI:1518129782
Name:HARTSELL, JEANNE ANN (PT, OCS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:8 W NORRIS RD STE B
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-1254
Practice Address - Country:US
Practice Address - Phone:865-494-6868
Practice Address - Fax:865-494-6867
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4193212OtherBLUE CROSS BLUE SHIELD OF TN
TN1506444Medicaid
TNCH4394OtherMEDICARE RAILROAD-GROUP
TN3650161Medicare UPIN