Healthcare Provider Details

I. General information

NPI: 1437027703
Provider Name (Legal Business Name): ALEX TEITELBAUM CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 KINGSTON PIKE STE 4
KNOXVILLE TN
37922-3240
US

IV. Provider business mailing address

10241 KINGSTON PIKE STE 4
KNOXVILLE TN
37922-3240
US

V. Phone/Fax

Practice location:
  • Phone: 865-672-6740
  • Fax: 865-672-6741
Mailing address:
  • Phone: 865-672-6740
  • Fax: 865-672-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number13276220
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number13276223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: