Provider Demographics
NPI:1811225410
Name:DEAN, JOHN B (PT, ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:DEAN
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 LAKE LOUDON BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-4009
Mailing Address - Country:US
Mailing Address - Phone:865-974-1900
Mailing Address - Fax:
Practice Address - Street 1:1551 LAKE LOUDON BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-4009
Practice Address - Country:US
Practice Address - Phone:865-974-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN010752255A2300X
TN7778225100000X
TN077782251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4277896OtherBLUECROSS BLUESHIELD
TN1521623Medicaid
TN1521623Medicaid
TN4277896OtherBLUECROSS BLUESHIELD