Healthcare Provider Details

I. General information

NPI: 1538110812
Provider Name (Legal Business Name): JENNIFER E. SPADAFORA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E. OLIVER PT

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8904 CROSS PARK DR
KNOXVILLE TN
37923-4703
US

IV. Provider business mailing address

PO BOX 32709
KNOXVILLE TN
37930-2709
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-2671
  • Fax: 865-690-6445
Mailing address:
  • Phone: 865-558-6484
  • Fax: 865-584-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number6404
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: