Provider Demographics
NPI:1386735298
Name:UNIVERSITY OF TENNESSEE
Entity type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR AND CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:COUNTS
Authorized Official - Last Name:LIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD, MBA
Authorized Official - Phone:901-448-5047
Mailing Address - Street 1:920 MADISON AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2243
Mailing Address - Country:US
Mailing Address - Phone:901-448-6438
Mailing Address - Fax:901-448-1411
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:SUITE EC013
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2243
Practice Address - Country:US
Practice Address - Phone:901-448-6438
Practice Address - Fax:901-448-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3133295OtherBC/BS PROVIDER NUMBER
TN0446645Medicaid
TN0446645Medicaid