Provider Demographics
NPI:1245327741
Name:PLEMONS, JEREMY K (PTA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:K
Last Name:PLEMONS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MARTINWOOD
Mailing Address - Street 2:STE 402
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5124
Mailing Address - Country:US
Mailing Address - Phone:865-691-5020
Mailing Address - Fax:865-691-5009
Practice Address - Street 1:4905 N BROADWAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2315
Practice Address - Country:US
Practice Address - Phone:865-689-8299
Practice Address - Fax:865-689-9804
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA3366225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant