Provider Demographics
NPI:1356422216
Name:IRWIN, MICHAEL LEE (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:IRWIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 BLUFF SHORE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6102
Mailing Address - Country:US
Mailing Address - Phone:865-640-6373
Mailing Address - Fax:865-483-7791
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:C 102
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-483-7790
Practice Address - Fax:865-483-7790
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist