Provider Demographics
NPI:1316236441
Name:REYNOLDS, JOHN HAROLD (CPO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HAROLD
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6205
Mailing Address - Country:US
Mailing Address - Phone:865-330-1183
Mailing Address - Fax:865-330-1186
Practice Address - Street 1:400 ERIN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6205
Practice Address - Country:US
Practice Address - Phone:865-330-1183
Practice Address - Fax:865-330-1186
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000167222Z00000X
TNPRO0000000138224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist