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NPI Code Detail

MEDICARE: MRS. LISA CAROL SCHUTT ATC

MEDICARE: MRS. LISA CAROL SCHUTT ATC
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
12255A2300XAthletic Trainer0000000103TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000000103OTHERTNSTATE LICENSE

General Provider Information

NPI Number : 1902872021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA CAROL SCHUTT ATC
Provider Business Mailing Address
First Line : 1416 ALDENWOOD LN
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-8401
Country : US
Telephone Number : 865-531-7679
Fax Number :
Provider Business Practice Location Address
First Line : 9430 PARK WEST BLVD
Second Line : SUITE 230
City : KNOXVILLE
State : TN
Zip : 37923-4200
Country : US
Telephone Number : 865-560-8550
Fax Number : 865-560-8551
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LISA CAROL SCHUTT ATC” Practice Location

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