Healthcare Provider Details

I. General information

NPI: 1609820471
Provider Name (Legal Business Name): KELLY JAY FERRIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CAMPBELL WAY
SEYMOUR TN
37865-6615
US

IV. Provider business mailing address

1015 CAMPBELL WAY
SEYMOUR TN
37865-6615
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-5557
  • Fax: 865-522-3218
Mailing address:
  • Phone: 865-573-5557
  • Fax: 865-522-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3641
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: