Provider Demographics
NPI:1689963522
Name:MUECKE, CHRISTY (PEDORTHIST)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:MUECKE
Suffix:
Gender:F
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-697-0057
Mailing Address - Fax:423-648-9366
Practice Address - Street 1:201 CENTER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2105
Practice Address - Country:US
Practice Address - Phone:865-966-4452
Practice Address - Fax:865-966-4457
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455062Medicaid
GA000973794CMedicaid
TN1507472Medicaid
GA000973794CMedicaid
1254770002Medicare NSC