MEDICARE: PHYLLIS A PERSICANO

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	151224962	TN

General Provider Information

NPI Number	:	1780510461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS A PERSICANO

Provider Business Mailing Address
First Line	:	5220 JACKSBORO PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-2415
Country	:	US
Telephone Number	:	513-379-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 VANOSDALE RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2497
Country	:	US
Telephone Number	:	865-297-4966
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ PHYLLIS A PERSICANO ” Practice Location

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