Provider Demographics
NPI:1306959788
Name:NEUROLOGY REHABILITATION SERVICES
Entity type:Organization
Organization Name:NEUROLOGY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-6919
Mailing Address - Street 1:PO BOX 53028
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-3028
Mailing Address - Country:US
Mailing Address - Phone:865-694-6919
Mailing Address - Fax:865-694-4339
Practice Address - Street 1:320 PARK 40 NORTH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-690-6660
Practice Address - Fax:865-690-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376542Medicare ID - Type Unspecified