| NPI | 1689148686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY CHAVEZ Practice Consultant 865-927-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 111N00000X Chiropractor | |
| 174N00000X Lactation Consultant, Non-RN | |
| 208000000X Pediatrics | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-28 |