Basic Information
| Provider Information | |||||||||
| NPI: | 1942397542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNIES | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 256 FORT SANDERS WEST BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657694545 | ||||||||
| FaxNumber: | 8657694501 | ||||||||
| Practice Location | |||||||||
| Address1: | 7557 DANNAHER WAY | ||||||||
| Address2: | SUITE G30 | ||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378493558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655121140 | ||||||||
| FaxNumber: | 8655121141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT7548 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3647370 | 05 | TN | MEDICAID | P01318052 | 01 | TN | RAILROAD MEDICARE | OTHER | 4134387 | 01 | TN | BLUECROSS BLUESHIELD | OTHER | 3654190 | 05 | TN | MEDICAID | 4355885 | 01 | TN | BLUECROSS BLUESHIELD | OTHER |