Healthcare Provider Details

I. General information

NPI: 1770572638
Provider Name (Legal Business Name): KRISTINE ALEES WOODRUM ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 S NORTHSHORE DR
KNOXVILLE TN
37922-6327
US

IV. Provider business mailing address

7601 HEUMSDALE DR
KNOXVILLE TN
37924-3847
US

V. Phone/Fax

Practice location:
  • Phone: 865-384-7086
  • Fax:
Mailing address:
  • Phone: 865-384-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number304
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: