Provider Demographics
NPI:1609928118
Name:PRO THERAPY SERVICES OF EAST TENNESSEE
Entity Type:Organization
Organization Name:PRO THERAPY SERVICES OF EAST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-908-3205
Mailing Address - Street 1:1103 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-908-7041
Mailing Address - Fax:865-908-7043
Practice Address - Street 1:2543 SAND PIKE BLVD
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6205
Practice Address - Country:US
Practice Address - Phone:865-908-3205
Practice Address - Fax:865-908-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5088261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651285Medicare ID - Type Unspecified