| Organization Name: | EAST TENNESSEE PHYSICAL THERAPY,LLC |
| NPI Number: | 1134504764 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DALE R CORUM (PROVIDER/OWNER) |
| Mailing Address: | 4357 Maynardville Hwy Maynardville |
| State: | TN US |
| Postal Code: | 37807 |
| Phone Number: | 8657451799 |
| Fax Number: | 8657451806 |
| NPI Enumeration Date: | 07/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5712 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |