Provider Demographics
NPI:1689633000
Name:PHYSICAL THERAPY SPECIALISTS PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-588-4108
Mailing Address - Street 1:6700 BAUM DR
Mailing Address - Street 2:STE 19
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7334
Mailing Address - Country:US
Mailing Address - Phone:865-588-4108
Mailing Address - Fax:865-474-1521
Practice Address - Street 1:6700 BAUM DR
Practice Address - Street 2:STE 19
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7334
Practice Address - Country:US
Practice Address - Phone:865-588-4108
Practice Address - Fax:865-474-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050291OtherBLUE CROSS BLUE SHIELD
TN3654677Medicaid
TN0166930001Medicare NSC
TN0050291OtherBLUE CROSS BLUE SHIELD