Provider Demographics
NPI:1255911657
Name:JEFFRIES, TERESA (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:TN
Mailing Address - Zip Code:37820-4229
Mailing Address - Country:US
Mailing Address - Phone:865-567-1340
Mailing Address - Fax:
Practice Address - Street 1:271 MOSS GROVE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-4458
Practice Address - Country:US
Practice Address - Phone:865-622-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6821225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant