Provider Demographics
NPI:1891184131
Name:MEDICAL REHAB CLINIC PLLC
Entity Type:Organization
Organization Name:MEDICAL REHAB CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHIRONNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-541-2465
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-541-2465
Mailing Address - Fax:865-541-1022
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-541-2465
Practice Address - Fax:865-541-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16759208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty