Provider Demographics
NPI:1811225410
Name:DEAN, JOHN B (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:DEAN
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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:865-231-9481
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:1551 LAKE LOUDON BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-4009
Practice Address - Country:US
Practice Address - Phone:865-974-1900
Practice Address - Fax:865-974-1259
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN077782251S0007X
TN010752255A2300X
TN7778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521623Medicaid
TN4277896OtherBLUECROSS BLUESHIELD
TN1521623Medicaid
TN4277896OtherBLUECROSS BLUESHIELD