Provider Demographics
NPI:1518954338
Name:BOND, RICKIE RAY (ATC,LAT, PTA)
Entity Type:Individual
Prefix:MR
First Name:RICKIE
Middle Name:RAY
Last Name:BOND
Suffix:
Gender:M
Credentials:ATC,LAT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5916
Mailing Address - Country:US
Mailing Address - Phone:865-323-4856
Mailing Address - Fax:
Practice Address - Street 1:2201 HIGHWAY 11W S
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-5276
Practice Address - Country:US
Practice Address - Phone:865-828-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000522255A2300X
TN5628246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other