Healthcare Provider Details

I. General information

NPI: 1306800594
Provider Name (Legal Business Name): BONNIE BASTIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S CONCORD ST
KNOXVILLE TN
37919-3309
US

IV. Provider business mailing address

7811 OAK RIDGE HWY STE 3
KNOXVILLE TN
37931-2345
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-2321
  • Fax: 865-637-4664
Mailing address:
  • Phone: 865-313-2445
  • Fax: 865-313-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1022
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: