Provider Demographics
NPI:1932676707
Name:SCHALLER, MATTHEW J (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9129 CROSS PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4505
Mailing Address - Country:US
Mailing Address - Phone:865-694-7725
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:9430 PARK WEST BLVD STE 230
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-560-8550
Practice Address - Fax:865-560-8551
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer