Healthcare Provider Details

I. General information

NPI: 1356087225
Provider Name (Legal Business Name): OPTIMAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 PARKSIDE DR
KNOXVILLE TN
37934-2659
US

IV. Provider business mailing address

8874 KINGSTON PIKE STE 100
KNOXVILLE TN
37923-5025
US

V. Phone/Fax

Practice location:
  • Phone: 865-288-4200
  • Fax: 865-531-9018
Mailing address:
  • Phone: 865-691-9055
  • Fax: 865-531-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY HUMPHREY
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 865-691-9055