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General NPI Number Information
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NPI Number | 1437635034
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Entity Type | Organization
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Legal Business Name | TRISTAR PHYSICAL THERAPY AND CHIROPRACTIC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 2024 E ANDREW JOHNSON HWY
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City | MORRISTOWN
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State | TN
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Zip | 37814-5410
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Country | US
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Telephone | 423-317-7772
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Fax | 423-317-7773
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Provider Business Mailing Address
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Address Line | 2024 E ANDREW JOHNSON HWY
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City | MORRISTOWN
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State | TN
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Zip | 37814-5410
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Country | US
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Telephone | 423-317-7772
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Fax |
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Authorized Official
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Title or Position | PT, DPT, OWNER
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Name | JORDAN BLACK
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Credential |
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Telephone | 423-258-2264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 11101
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License Number State | TN
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