MEDICARE: DAVID MICHAEL SHOTT LPTA

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	225200000X	Physical Therapy Assistant	PTA0000003956	TN

General Provider Information

NPI Number	:	1659444107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL SHOTT LPTA

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	4738 CENTERLINE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-1401
Country	:	US
Telephone Number	:	865-546-0801
Fax Number	:	865-546-0086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/03/2013

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