Provider Demographics
NPI:1619041530
Name:MUNSON, RODNEY SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:SCOTT
Last Name:MUNSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 OAKWOOD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-7014
Mailing Address - Country:US
Mailing Address - Phone:865-368-0691
Mailing Address - Fax:
Practice Address - Street 1:3131 TOM AUSTIN PARKWAY HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFEILD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-382-7979
Practice Address - Fax:615-382-7909
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPTA2113Other2113