Basic Information
| Provider Information | |||||||||
| NPI: | 1669854527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IVEY | ||||||||
| FirstName: | COREY | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312 TRANQUILITY TRL | ||||||||
| Address2: | |||||||||
| City: | DANDRIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377255412 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 CAVETTE HILL LN | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379346673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657774000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2015 | ||||||||
| LastUpdateDate: | 06/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5939 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.