Provider Demographics
NPI:1316250004
Name:MCCALLISTER, LAURA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEIGH
Last Name:MCCALLISTER
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 1:3024 BUSINESS PARK CIR STE 209
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-251-3030
Practice Address - Fax:865-966-0191
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I653937Medicare PIN