Basic Information
| Provider Information | |||||||||
| NPI: | 1275299034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOX PHYSIO ORTHOPELVIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11409 MUNICIPAL CENTER DR # 22243 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379222841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653157515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 CATLETT RD | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379323106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653157515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | CAPPS | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8653157515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 12662 | 01 | TN | STATE LICENSE NUMBER | OTHER |