Provider Demographics
NPI:1952395907
Name:PRYOR, KAREN D (PT, DPT, PHD)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:D
Last Name:PRYOR
Suffix:
Gender:F
Credentials:PT, DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:423-939-4006
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36524041Medicaid
TN0158816OtherBLUE CROSS
11743225OtherCAQH
TN0158816OtherBLUE CROSS