Provider Demographics
NPI:1558011486
Name:BAGGETT, JOSEE CAMRYN (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEE
Middle Name:CAMRYN
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 AMBER DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-4632
Mailing Address - Country:US
Mailing Address - Phone:865-456-2394
Mailing Address - Fax:
Practice Address - Street 1:309 GARDNER RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3418
Practice Address - Country:US
Practice Address - Phone:865-679-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty