{
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"IsOrgSubpart": "N",
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"OrgName": "EAST TENNESSEE SPINE & SPORT INC",
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"NameSuffix": null,
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"FirstLineMailingAddress": "4905 N BROADWAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KNOXVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37918-2315",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-689-8299",
"MailingAddressFaxNumber": "865-689-9804",
"FirstLinePracticeLocationAddress": "150 N MARTINWOOD RD",
"SecondLinePracticeLocationAddress": "SUITE 402",
"PracticeLocationAddressCityName": "KNOXVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37923-5124",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-691-5020",
"PracticeLocationAddressFaxNumber": "865-691-5009",
"EnumerationDate": "10/02/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEFILIPPO",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": "JOHN",
"AuthorizedOfficialTitle": "PRESIDENT OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHYSICAL THERAPIST",
"AuthorizedOfficialTelephoneNumber": "865-689-8299",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}