Active NPI
Constance V Peterson, PT
- Pediatric Physical Therapist
- Kingston, TN
National Provider Identifier
1851323067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1095
- Practice address
- 187 Gallaher Rd
Kingston, TN 37763-4721 - Phone
- (865) 376-4620
- Fax
- (865) 376-1759
- NPI assigned
- Jul 7, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1095 | TN | Primary |
Addresses
Primary practice location
187 Gallaher Rd
Kingston, TN 37763-4721
Mailing address
211 Center Park Drive
Suite 3060
Knoxville, TN 37922
Phone (865) 966-8545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5440745 | Medicaid | TN | |
| 4005129 | Other | TN | BLUECROSS BLUESHIELD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1095 | TN | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jane K Bryant | 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 and National Provider Directory roles.
-
- Specialist
- Kingston, TN
- NPI 1558560474
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851323067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 CENTER PARK DRIVE",
"address_2": "SUITE 3060",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "37922",
"telephone_number": "865-966-8545",
"fax_number": "865-966-3936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 GALLAHER RD",
"city": "KINGSTON",
"state": "TN",
"postal_code": "377634721",
"telephone_number": "865-376-4620",
"fax_number": "865-376-1759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CONSTANCE",
"middle_name": "V",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TN",
"license": "1095",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5440745",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "4005129",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingston, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.