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General NPI Number Information
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NPI Number | 1992947527
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Entity Type | Organization
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Legal Business Name | TENNESSEE SPORTS MEDICINE GROUP
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 2260 SUTHERLAND AVE
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City | KNOXVILLE
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State | TN
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Zip | 37919-2350
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Country | US
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Telephone | 865-951-2975
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Fax | 865-951-2972
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Provider Business Mailing Address
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Address Line | PO BOX 440094
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City | NASHVILLE
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State | TN
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Zip | 37244-0094
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Country | US
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Telephone | 865-670-6199
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Fax | 865-670-6188
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Authorized Official
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Title or Position | OWNER
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Name | JOHN H KRUSENKLAUS
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Credential | PT
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Telephone | 865-951-2975
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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 |
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License Number State | TN
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