Provider Demographics
NPI:1922570605
Name:NEELY, CAREYE JOLENE (PT)
Entity Type:Individual
Prefix:
First Name:CAREYE
Middle Name:JOLENE
Last Name:NEELY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-0096
Mailing Address - Country:US
Mailing Address - Phone:865-745-1799
Mailing Address - Fax:865-745-1806
Practice Address - Street 1:2255 HIGHWAY 25E STE 4
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3857
Practice Address - Country:US
Practice Address - Phone:423-626-7848
Practice Address - Fax:423-626-7849
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist