Provider Demographics
NPI:1154720654
Name:ANDRES, CARISSA (ATC/LAT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-9502
Mailing Address - Country:US
Mailing Address - Phone:865-908-9248
Mailing Address - Fax:
Practice Address - Street 1:170 COMMUNITY CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863
Practice Address - Country:US
Practice Address - Phone:865-908-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine