Provider Demographics
NPI:1619272416
Name:CHANNELL, GREGORY ROSS (DPT, MOT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROSS
Last Name:CHANNELL
Suffix:
Gender:M
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-4102
Mailing Address - Country:US
Mailing Address - Phone:865-932-1334
Mailing Address - Fax:865-932-1374
Practice Address - Street 1:8309 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-4102
Practice Address - Country:US
Practice Address - Phone:865-932-1334
Practice Address - Fax:865-932-1374
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8573225100000X
TN4143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist