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General NPI Number Information
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NPI Number | 1245319185
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Entity Type | Individual
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Provider Name | TIMOTHY DEAN DOUGLASS P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 1400 DOWELL SPRINGS BLVD SUITE 120
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City | KNOXVILLE
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State | TN
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Zip | 37909-2456
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Country | US
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Telephone | 865-232-1415
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Fax | 865-232-1416
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Provider Business Mailing Address
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Address Line | 1400 DOWELL SPRINGS BLVD SUITE 120
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City | KNOXVILLE
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State | TN
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Zip | 37909-2456
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Country | US
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Telephone | 865-898-7901
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Fax | 865-691-8303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT0000006307
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License Number State | TN
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