MEDICARE: JUSTIN CALLIS PT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1861147415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN CALLIS PT

Provider Business Mailing Address
First Line	:	3301 ORANGE BLOSSOM LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-2182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 ORANGE BLOSSOM LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37931-2182
Country	:	US
Telephone Number	:	731-514-0277
Fax Number	:

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

Provider Enumeration Date	:	02/12/2022
Last Update Date	:	02/12/2022

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Directions to “ JUSTIN CALLIS PT” Practice Location

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