Provider Demographics
NPI:1801892195
Name:ROCKWELL, ERIC H (PT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:H
Last Name:ROCKWELL
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 1:6700 BAUM DRIVE
Mailing Address - Street 2:STE 19
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7334
Mailing Address - Country:US
Mailing Address - Phone:865-588-4108
Mailing Address - Fax:865-474-1521
Practice Address - Street 1:6700 BAUM DRIVE
Practice Address - Street 2:STE 19
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7334
Practice Address - Country:US
Practice Address - Phone:865-588-4108
Practice Address - Fax:865-474-1521
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-05-18
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TNPT762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN650008552OtherRAILROAD MEDICARE
TN2005539OtherBLUE CROSS BLUE SHIELD
TNTN0101OtherJOHN DEERE
TN3654677Medicaid
TN650008552OtherRAILROAD MEDICARE
TNTN0101OtherJOHN DEERE
TN3654677Medicare ID - Type UnspecifiedMEDICARE FACILITY ID