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General NPI Number Information
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NPI Number | 1023101144
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE SPINE & SPORT INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 N MARTINWOOD RD SUITE 402
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City | KNOXVILLE
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State | TN
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Zip | 37923-5124
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Country | US
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Telephone | 865-691-5020
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Fax | 865-691-5009
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Provider Business Mailing Address
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Address Line | 4905 N BROADWAY ST
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City | KNOXVILLE
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State | TN
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Zip | 37918-2315
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Country | US
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Telephone | 865-689-8299
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Fax | 865-689-9804
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | GREGORY JOHN DEFILIPPO
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Credential | PHYSICAL THERAPIST
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Telephone | 865-689-8299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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