Provider Demographics
NPI:1629036314
Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRONNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-541-1167
Mailing Address - Street 1:1901 W CLINCH AVE
Mailing Address - Street 2:SUITE 301EAST
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2307
Mailing Address - Country:US
Mailing Address - Phone:865-541-1167
Mailing Address - Fax:865-541-3977
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:SUITE 301EAST
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-541-1167
Practice Address - Fax:865-541-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709768Medicaid
TN3709768Medicare ID - Type Unspecified