Tri State Sports Medicine and Rehabilitation Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3108 Issued in TN

Legal business name

TRI STATE SPORTS MEDICINE AND REHABILITATION INC

Doing business as

East Tennessee Physical Therapy Inc

Practice address

2255 Highway 25E Ste 4
Tazewell, TN 37879

Phone

(423) 626-7848

Fax

(423) 626-7849

NPI assigned

Nov 1, 2006

Organization subpart

Yes

Parent organization

TRI STATE SPORTS MEDICINE AND REHABILITAION, INCAs reported in NPPES

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

Authorized official

Name

Dale Richard Corum

Title

Owner

Phone

(423) 626-7848

Specialties & licenses 1

Addresses

Other names 1

• East Tennessee Physical Therapy Inc Doing business as

Part of

Tri-State Sports Medicine and Rehabilitation Inc

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason R Stooksbury, PT

  • Physical Therapist
  • La Follette, TN
  • NPI 1649351321
  NPD (past)
• Camden H Campbell, DPT

  • Physical Therapist
  • Pikeville, KY
  • NPI 1811241581
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1922185644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1310",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "378491310",
            "telephone_number": "865-805-1218",
            "fax_number": "423-626-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 HIGHWAY 25E STE 4",
            "city": "TAZEWELL",
            "state": "TN",
            "postal_code": "37879",
            "telephone_number": "423-626-7848",
            "fax_number": "423-626-7849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE SPORTS MEDICINE AND REHABILITATION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI STATE SPORTS MEDICINE AND REHABILITAION, INC",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "CORUM",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-626-7848"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "3108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Tennessee Physical Therapy Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• George Thompson, PA-C
• Trail of the Cumberlands Anesthesia Associates
• Tri-State Radiology
• Deane Turner
• Value RX LLC
• Kyler Vogel, PA-C
• Sunan Vongkasemsiri, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.