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General NPI Number Information
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NPI Number | 1558485607
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Entity Type | Individual
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Provider Name | JEREMY SHANE DEVOTI PT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1420 TUSCULUM BLVD
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City | GREENEVILLE
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State | TN
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Zip | 37745-4279
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Country | US
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Telephone | 423-787-5063
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Fax |
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Provider Business Mailing Address
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Address Line | 208 DOGWOOD DR
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City | GREENEVILLE
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State | TN
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Zip | 37745-6412
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Country | US
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Telephone | 423-636-7517
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0000003175
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8794
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License Number State | TN
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