Provider Demographics
NPI:1689608887
Name:SHAW-JOHNSON, JOANNE L (BSPT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:SHAW-JOHNSON
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 PARKSIDE DR STE 303
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2662
Mailing Address - Country:US
Mailing Address - Phone:865-218-9330
Mailing Address - Fax:
Practice Address - Street 1:11440 PARKSIDE DR STE 303
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2662
Practice Address - Country:US
Practice Address - Phone:865-218-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441397Medicaid
TN4343208OtherBLUECROSS BLUESHIELD
TN4343208OtherBLUECROSS BLUESHIELD
TN446631Medicare ID - Type UnspecifiedGROUP