Healthcare Provider Details

I. General information

NPI: 1366529893
Provider Name (Legal Business Name): MICHAEL ANDREW SPADAFORA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5822 LYONS VIEW PIKE
KNOXVILLE TN
37919-6460
US

IV. Provider business mailing address

5822 LYONS VIEW PIKE
KNOXVILLE TN
37919-6460
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-6358
  • Fax: 865-909-9949
Mailing address:
  • Phone: 865-588-6358
  • Fax: 865-909-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000006180
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: