Healthcare Provider Details

I. General information

NPI: 1922050475
Provider Name (Legal Business Name): MARY K. KEARSE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY K. WILSON PT

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 TAZEWELL PIKE
KNOXVILLE TN
37918-1879
US

IV. Provider business mailing address

1400 DOWELL SPRINGS BLVD STE 120
KNOXVILLE TN
37909-2450
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-1512
  • Fax: 865-687-2138
Mailing address:
  • Phone: 865-232-1415
  • Fax: 865-232-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6119
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: