Healthcare Provider Details

I. General information

NPI: 1700350758
Provider Name (Legal Business Name): KATHY RENEA CARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 01/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 SHERRILL BLVD
KNOXVILLE TN
37932-3347
US

IV. Provider business mailing address

221 GILBERT LN
KNOXVILLE TN
37920-3678
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-2204
  • Fax:
Mailing address:
  • Phone: 865-388-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5156
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: