Provider Demographics
NPI:1851584155
Name:PENDERGRASS, WILLIAM R (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:PENDERGRASS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:PENDERGRASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:STE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:7337 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5608
Practice Address - Country:US
Practice Address - Phone:865-588-1046
Practice Address - Fax:865-588-1048
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist