Healthcare Provider Details

I. General information

NPI: 1316250004
Provider Name (Legal Business Name): LAURA LEIGH MCCALLISTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR SUITE 209
KNOXVILLE TN
37934-1979
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR STE 209
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-3030
  • Fax: 865-966-0191
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8740
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: