=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326078643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW CIESLIK PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 04/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9257 MIDDLEBROOK PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37931-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-566-0100
-----------------------------------------------------
Fax | 865-566-0099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9257 MIDDLEBROOK PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37931-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-566-0100
-----------------------------------------------------
Fax | 865-566-0099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT03365
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------