=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831774009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRISTEN ALLYN SELLERS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2021
-----------------------------------------------------
Last Update Date | 03/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 E GOVERNOR JOHN SEVIER HWY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-6713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-609-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4317 LANDON DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37921-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-335-4780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 13308
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------