Provider Demographics
NPI:1194174219
Name:INSO, DAVID JEREMIAH (PTA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JEREMIAH
Last Name:INSO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 E EMORY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4617
Mailing Address - Country:US
Mailing Address - Phone:865-947-6622
Mailing Address - Fax:865-947-6624
Practice Address - Street 1:11201 W POINT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2833
Practice Address - Country:US
Practice Address - Phone:865-392-6001
Practice Address - Fax:865-392-6003
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5508225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant