Healthcare Provider Details

I. General information

NPI: 1215452230
Provider Name (Legal Business Name): STACEY RENEA COLE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY R SHELTON DPT

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 ASHEVILLE HWY
KNOXVILLE TN
37924-3005
US

IV. Provider business mailing address

203 NARROWS PKWY STE D
BIRMINGHAM AL
35242-8649
US

V. Phone/Fax

Practice location:
  • Phone: 865-465-6100
  • Fax: 865-465-6101
Mailing address:
  • Phone: 205-719-2420
  • Fax: 205-719-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12351
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: