| Organization Name: | TRI-STATE SPORTS MEDICINE AND REHABILITATION INC |
| NPI Number: | 1326253261 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN D STALEY (OWNER) |
| Mailing Address: | 102 N Massachusetts Ave Suite 6 La Follette |
| State: | TN US |
| Postal Code: | 377662847 |
| Phone Number: | 4239070064 |
| Fax Number: | 4239070065 |
| NPI Enumeration Date: | 05/14/2007 |
| NPI Last Update Date: | 03/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3108 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |