Healthcare Provider Details

I. General information

NPI: 1972721769
Provider Name (Legal Business Name): DONNA M EDWARDS PT OCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10429 HICKORY PATH WAY
KNOXVILLE TN
37922-3296
US

IV. Provider business mailing address

10429 HICKORY PATH WAY
KNOXVILLE TN
37922-3296
US

V. Phone/Fax

Practice location:
  • Phone: 865-560-2709
  • Fax: 865-560-2710
Mailing address:
  • Phone: 865-560-2709
  • Fax: 865-560-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0000001656
License Number StateTN

VIII. Authorized Official

Name: MS. DONNA MARIE EDWARDS
Title or Position: PRESIDENT OWNER
Credential: PT OCS
Phone: 865-560-2709