Provider Demographics
NPI:1962803320
Name:JUSTICE, DANIEL KEITH (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEITH
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-285-6647
Practice Address - Street 1:4635 GREENWAY DR
Practice Address - Street 2:UNIT B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2118
Practice Address - Country:US
Practice Address - Phone:423-238-7217
Practice Address - Fax:423-285-6647
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008154225100000X
TN10135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist