Healthcare Provider Details

I. General information

NPI: 1326654799
Provider Name (Legal Business Name): REPLENISH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 E RED BUD RD
KNOXVILLE TN
37920-8807
US

IV. Provider business mailing address

PO BOX 9385
KNOXVILLE TN
37940-0385
US

V. Phone/Fax

Practice location:
  • Phone: 865-269-2570
  • Fax: 865-269-2558
Mailing address:
  • Phone: 865-269-2570
  • Fax: 868-269-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BETHANY TOWNSEND
Title or Position: OWNER/OPERATOR
Credential: L.C.S.W.
Phone: 865-269-2570