Provider Demographics
NPI:1861500993
Name:IVERSON, PAUL NED (DPT, MTC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NED
Last Name:IVERSON
Suffix:
Gender:M
Credentials:DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2714
Mailing Address - Country:US
Mailing Address - Phone:423-648-4490
Mailing Address - Fax:423-648-4491
Practice Address - Street 1:1201 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2714
Practice Address - Country:US
Practice Address - Phone:423-648-4490
Practice Address - Fax:423-648-4491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6542225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6542OtherLICENSE#