Provider Demographics
NPI:1578682936
Name:NEWBERRY, DONNIE ELMER JR (PT)
Entity Type:Individual
Prefix:MR
First Name:DONNIE
Middle Name:ELMER
Last Name:NEWBERRY
Suffix:JR
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-0608
Mailing Address - Country:US
Mailing Address - Phone:423-375-8907
Mailing Address - Fax:423-822-5514
Practice Address - Street 1:325 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2237
Practice Address - Country:US
Practice Address - Phone:423-317-7772
Practice Address - Fax:423-317-7773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1265OtherPT