Provider Demographics
NPI:1922050475
Name:KEARSE, MARY K (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:KEARSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2450
Mailing Address - Country:US
Mailing Address - Phone:865-232-1415
Mailing Address - Fax:865-232-1416
Practice Address - Street 1:2910 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1879
Practice Address - Country:US
Practice Address - Phone:865-687-1512
Practice Address - Fax:865-687-2138
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3652954Medicaid
TN3154490OtherBLUE CROSS
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN3652954Medicare ID - Type Unspecified