Provider Demographics
NPI:1689608887
Name:SHAW-JOHNSON, JOANNE L (BSPT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:SHAW-JOHNSON
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:11440 PARKSIDE DR STE 303
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2662
Practice Address - Country:US
Practice Address - Phone:865-218-9330
Practice Address - Fax:865-218-9338
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4343208OtherBLUECROSS BLUESHIELD
TN5441397Medicaid
TN4343208OtherBLUECROSS BLUESHIELD
TN446631Medicare ID - Type UnspecifiedGROUP