Provider Demographics
NPI:1710940820
Name:KILES, MICHELLE P (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:P
Last Name:KILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N PARK 40 BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3615
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:465 N PARK 40 BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3615
Practice Address - Country:US
Practice Address - Phone:865-357-5088
Practice Address - Fax:865-691-3617
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3645785Medicaid
TN4110126OtherBLUE CROSS BLUE SHIELD
3645785Medicare ID - Type Unspecified