Healthcare Provider Details

I. General information

NPI: 1588944904
Provider Name (Legal Business Name): BEVIN CAMILE KERECHANIN D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E WEISGARBER RD SUITE 180 SOUTH
KNOXVILLE TN
37909-2604
US

IV. Provider business mailing address

8361 BLOCK HOUSE WAY
KNOXVILLE TN
37923-0900
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-5558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.012178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: