Provider Demographics
NPI:1841393477
Name:DEFILIPPO, GREGORY J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:DEFILIPPO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MARTINWOOD
Mailing Address - Street 2:STE 402
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5124
Mailing Address - Country:US
Mailing Address - Phone:865-691-5020
Mailing Address - Fax:865-691-5009
Practice Address - Street 1:4905 N BROADWAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2315
Practice Address - Country:US
Practice Address - Phone:865-689-8299
Practice Address - Fax:865-689-9804
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT4078225100000X
CAPT19539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3040730Medicaid
TN364190Medicaid
TN3040730Medicaid