Active NPI
Teia Squires Fuller, PT, DPT
- Physical Therapist
- Knoxville, TN
National Provider Identifier
1467539783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8082
- Practice address
- 8904 Cross Park Dr
Knoxville, TN 37923-4703 - Phone
- (865) 690-2671
- Fax
- (865) 690-6445
- NPI assigned
- Nov 1, 2006
- Last updated
- Jun 24, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5293 | SC | |
| Physical Therapist | 225100000X | 8082 | TN | Primary |
Addresses
Primary practice location
8904 Cross Park Dr
Knoxville, TN 37923-4703
Mailing address
PO Box 32709
Knoxville, TN 37930-2709
Phone (865) 558-6484
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3650210 | Medicaid | TN | |
| 4214519 | Other | TN | BLUE CROSS BLUE SHIELD OF TN |
| CH4394 | Other | TN | MEDICARE RAILROAD GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8082 | TN | MD | Physical Therapist |
| 5293 | SC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Center Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277337600000",
"number": "1467539783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 32709",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379302709",
"telephone_number": "865-558-6484",
"fax_number": "865-584-4037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8904 CROSS PARK DR",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234703",
"telephone_number": "865-690-2671",
"fax_number": "865-690-6445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "TEIA",
"middle_name": "SQUIRES",
"name_prefix": "Mrs.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2010-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "5293",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "8082",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3650210",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF TN",
"identifier": "4214519",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD GROUP",
"identifier": "CH4394",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.