Provider Demographics
NPI:1730134008
Name:PIERCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PIERCE PHYSICAL THERAPY
Other - Org Name:PIERCE SPORTS THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:865-483-0383
Mailing Address - Street 1:661 EMORY VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7763
Mailing Address - Country:US
Mailing Address - Phone:865-483-0383
Mailing Address - Fax:865-483-0533
Practice Address - Street 1:661 EMORY VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7763
Practice Address - Country:US
Practice Address - Phone:865-483-0383
Practice Address - Fax:865-483-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5564393OtherAETNA
TN3724563Medicaid
TN4023490OtherBLUE CROSS BLUE SHIELD
TN1134919OtherUNITED HEALTHCARE
TN4023490OtherBLUE CROSS BLUE SHIELD