Basic Information
| Provider Information | |||||||||
| NPI: | 1053374298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11440 PARKSIDE DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379342658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657694545 | ||||||||
| FaxNumber: | 8657694501 | ||||||||
| Practice Location | |||||||||
| Address1: | 11440 PARKSIDE DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379342658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657694545 | ||||||||
| FaxNumber: | 8657694501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 03/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6610 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3651358 | 05 | TN | MEDICAID | 4103266 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |