Provider Demographics
NPI:1700081759
Name:HEALTH SPHERE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HEALTH SPHERE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PHD
Authorized Official - Phone:423-939-4003
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-0456
Mailing Address - Country:US
Mailing Address - Phone:423-939-4003
Mailing Address - Fax:423-939-4006
Practice Address - Street 1:3703 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-0436
Practice Address - Country:US
Practice Address - Phone:423-939-4003
Practice Address - Fax:615-781-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0158816OtherBLUE CROSS
TN3652404Medicaid
TN3652404Medicaid