Healthcare Provider Details

I. General information

NPI: 1437635034
Provider Name (Legal Business Name): TRISTAR PHYSICAL THERAPY AND CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 E ANDREW JOHNSON HWY
MORRISTOWN TN
37814-5410
US

IV. Provider business mailing address

2024 E ANDREW JOHNSON HWY
MORRISTOWN TN
37814-5410
US

V. Phone/Fax

Practice location:
  • Phone: 423-317-7772
  • Fax: 423-317-7773
Mailing address:
  • Phone: 423-317-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11101
License Number StateTN

VIII. Authorized Official

Name: JORDAN BLACK
Title or Position: PT, DPT, OWNER
Credential:
Phone: 423-258-2264