Healthcare Provider Details

I. General information

NPI: 1063036531
Provider Name (Legal Business Name): MARK D KIRSHNER FOOT BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 MINERAL SPRINGS AVE STE A
KNOXVILLE TN
37917-1570
US

IV. Provider business mailing address

2620 MINERAL SPRINGS AVE STE A
KNOXVILLE TN
37917-1570
US

V. Phone/Fax

Practice location:
  • Phone: 865-247-4809
  • Fax: 865-247-4927
Mailing address:
  • Phone: 865-247-4809
  • Fax: 865-247-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARK KIRSHNER
Title or Position: OWNER
Credential:
Phone: 865-247-4809