Provider Demographics
NPI:1306895784
Name:GAGER, JOSEPH MATTHEW (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:GAGER
Suffix:
Gender:M
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:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0767
Mailing Address - Country:US
Mailing Address - Phone:423-338-8088
Mailing Address - Fax:423-338-8188
Practice Address - Street 1:217 WARD ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-3054
Practice Address - Country:US
Practice Address - Phone:423-338-8088
Practice Address - Fax:423-338-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-01-18
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-01-18
Provider Licenses
StateLicense IDTaxonomies
TNPT0000005914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN105258400OtherDEPT OF LABOR
TN3652560Medicaid
TN4030037OtherBCBS