MEDICARE: ORTHOTENNESSEE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3711622	OTHER	TN	MEDICARE

General Provider Information

NPI Number	:	1316133945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTENNESSEE, PC

Provider Business Mailing Address
First Line	:	460 MEDICAL PARK DRIVE
Second Line	:	SUITE 105
City	:	LENOIR CITY
State	:	TN
Zip	:	37772
Country	:	US
Telephone Number	:	865-988-3925
Fax Number	:	865-988-6986

Provider Business Practice Location Address
First Line	:	460 MEDICAL PARK DRIVE
Second Line	:	SUITE 105
City	:	LENOIR CITY
State	:	TN
Zip	:	37772
Country	:	US
Telephone Number	:	865-988-3925
Fax Number	:	865-988-6986

Authorized Official
Title or Position	:	CEO
Name	:	GLENN SUMNER
Credential	:
Telephone Number	:	865-769-4545

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	03/13/2009

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Directions to “ORTHOTENNESSEE, PC ” Practice Location

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