MEDICARE: MR. TIMOTHY DEAN DOUGLASS P.T.

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
1	225100000X	Physical Therapist	PT0000006307	TN

General Provider Information

NPI Number	:	1245319185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY DEAN DOUGLASS P.T.

Provider Business Mailing Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 120
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-898-7901
Fax Number	:	865-691-8303

Provider Business Practice Location Address
First Line	:	1400 DOWELL SPRINGS BLVD
Second Line	:	SUITE 120
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2456
Country	:	US
Telephone Number	:	865-232-1415
Fax Number	:	865-232-1416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/03/2021

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