Healthcare Provider Details

I. General information

NPI: 1902761547
Provider Name (Legal Business Name): CHRISTIAN SALVATORE MARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLINCH AVE
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

1233 GABY HILLS DR
DANDRIDGE TN
37725-4846
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-1111
  • Fax:
Mailing address:
  • Phone: 865-607-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8644
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: