Healthcare Provider Details

I. General information

NPI: 1861153694
Provider Name (Legal Business Name): MICHAEL BRETT ROLISON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4329 W ANDREW JOHNSON HWY STE 1
MORRISTOWN TN
37814-1181
US

IV. Provider business mailing address

4329 W ANDREW JOHNSON HWY STE 1
MORRISTOWN TN
37814-1181
US

V. Phone/Fax

Practice location:
  • Phone: 423-616-5965
  • Fax: 423-616-5966
Mailing address:
  • Phone: 423-616-5965
  • Fax: 423-616-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14684
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP20220
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: