Healthcare Provider Details

I. General information

NPI: 1477812196
Provider Name (Legal Business Name): OPTIMAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8874 KINGSTON PIKE
KNOXVILLE TN
37923-5010
US

IV. Provider business mailing address

8874 KINGSTON PIKE STE. 202
KNOXVILLE TN
37923-5010
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4200
  • Fax: 865-531-9018
Mailing address:
  • Phone: 865-691-9055
  • Fax: 865-531-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY A HUMPHREY
Title or Position: PROVIDER RELATIONS/COMPLIANCE OFFIC
Credential:
Phone: 865-691-9055