Healthcare Provider Details

I. General information

NPI: 1316236441
Provider Name (Legal Business Name): JOHN HAROLD REYNOLDS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ERIN DR
KNOXVILLE TN
37919-6205
US

IV. Provider business mailing address

400 ERIN DR
KNOXVILLE TN
37919-6205
US

V. Phone/Fax

Practice location:
  • Phone: 865-330-1183
  • Fax: 865-330-1186
Mailing address:
  • Phone: 865-330-1183
  • Fax: 865-330-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT0000000167
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPRO0000000138
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: