Healthcare Provider Details

I. General information

NPI: 1619500899
Provider Name (Legal Business Name): BARBELL PERFORMANCE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9607 EVA MARIE WAY # 216
KNOXVILLE TN
37931-4278
US

IV. Provider business mailing address

9607 EVA MARIE WAY # 216
KNOXVILLE TN
37931-4278
US

V. Phone/Fax

Practice location:
  • Phone: 801-824-1984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND CROSS
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 801-824-1984