Healthcare Provider Details

I. General information

NPI: 1508071978
Provider Name (Legal Business Name): DAVID RAIE MCJUNKIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 NEW HIGHWAY 68 UNIT 1
TELLICO PLAINS TN
37385-5347
US

IV. Provider business mailing address

1655 MECCA PIKE
TELLICO PLAINS TN
37385-0000
US

V. Phone/Fax

Practice location:
  • Phone: 423-253-6522
  • Fax:
Mailing address:
  • Phone: 423-253-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: