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NPI Code Detail

MEDICARE: NOAH GARDNER PTA

MEDICARE: NOAH GARDNER PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1114574027
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOAH GARDNER PTA
Provider Business Mailing Address
First Line : 817 WOODDALE CHURCH RD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37924-4340
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7228 NORRIS FWY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37918-5744
Country : US
Telephone Number : 865-377-3176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2019
Last Update Date : 08/26/2019

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