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General NPI Number Information
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NPI Number | 1992976013
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Entity Type | Organization
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Legal Business Name | SPIRIT PROSTHETICS
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 211 E BLOUNT AVE SUITE 701
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City | KNOXVILLE
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State | TN
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Zip | 37920-1614
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Country | US
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Telephone | 865-549-4599
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Fax | 865-549-4598
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Provider Business Mailing Address
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Address Line | 4728 TILLERY RD
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City | KNOXVILLE
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State | TN
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Zip | 37912-5400
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Country | US
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Telephone | 865-363-3513
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Fax | 865-549-4598
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Authorized Official
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Title or Position | OWNER/PROSTHETIST
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Name | MR. BRIAN D JOHNSON
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Credential | CP, LP
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Telephone | 865-363-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0900X
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Taxonomy Name | Amputee Clinic/Center
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License Number | PRO0000000113
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License Number State | TN
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