Ethan Joel Dudley

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13412 Issued in TN

Practice address

1632 W Broadway Ave
Maryville, TN 37801-5600

Phone

(865) 984-1996

Fax

(865) 984-1997

NPI assigned

May 3, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agilitas USA, IncGroup PAC ID 3375454648, 812 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agilitas USA Inc

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Independent Physical Therapy, LLC

  • Physical Therapist
  • Chattanooga, TN
  • NPI 1104878354
  Medicare reassignment NPD
• Agilitas USA, Inc

  • Physical Therapy Clinic/Center
  • Chattanooga, TN
  • NPI 1518695436

  Physical Therapist

  NPD
• Agilitas USA, Inc

  • Physical Therapy Clinic/Center
  • Memphis, TN
  • NPI 1649434994
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1750964284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306393",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306393",
            "telephone_number": "615-373-1350",
            "fax_number": "615-373-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1632 W BROADWAY AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378015600",
            "telephone_number": "865-984-1996",
            "fax_number": "865-984-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "ETHAN",
        "middle_name": "JOEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell C Dreyer, D.C.
• Brittany Bay Droste, MSSW
• Jeremy Drumlake, PHARMD
• Brenda-Lee Wilder Duarte, LPC-MHSP
• Traci Dubuque, FNP-BC
• Ketlin Duff
• Meaghan Catherine Dullea, PT, DPT
• Marcella Horn Dunaway, PHD
• Carrie Beth Clark Duncanson, ATC
• Stephen John Dunkley, FNP-C

• Physical Therapist in Maryville, TN
• Providers in Maryville, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.