Provider Demographics
NPI:1194762369
Name:MYERS, AMY GREGORY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:GREGORY
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 CHAPMAN HWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-4267
Mailing Address - Country:US
Mailing Address - Phone:865-573-6458
Mailing Address - Fax:
Practice Address - Street 1:4011 CHAPMAN HWY
Practice Address - Street 2:SUITE J
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4267
Practice Address - Country:US
Practice Address - Phone:865-573-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4125831OtherBCBS TN
TN4125831OtherBCBS TN