Provider Demographics
NPI:1972721769
Name:DONNA M EDWARDS PT OCS
Entity Type:Organization
Organization Name:DONNA M EDWARDS PT OCS
Other - Org Name:MOUNTAIN SPIRIT PHYSICAL THERAPY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:865-560-2709
Mailing Address - Street 1:10429 HICKORY PATH WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3296
Mailing Address - Country:US
Mailing Address - Phone:865-560-2709
Mailing Address - Fax:865-560-2710
Practice Address - Street 1:10429 HICKORY PATH WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3296
Practice Address - Country:US
Practice Address - Phone:865-560-2709
Practice Address - Fax:865-560-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001656261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729027Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBAR