Healthcare Provider Details

I. General information

NPI: 1285860015
Provider Name (Legal Business Name): GREG KEITH SPURLING PTA MSS ATC/L EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 VOLUNTEER PKWY STE 6
BRISTOL TN
37620-6067
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-652-0265
  • Fax: 423-652-0574
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6018
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number069502664
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number540
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: