Individual
LOGAN B. PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1422 OLD WEISGARBER RD, KNOXVILLE, TN 37909-1293
(865) 558-4480
(865) 558-4481
Mailing address
1422 OLD WEISGARBER RD, KNOXVILLE, TN 37909-1293
(865) 558-4480
(865) 558-4481
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8854
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523478
—
TN
01
—
4288724
BLUECROSS BLUESHIELD
TN
01
—
5792655
CIGNA
TN
01
—
P01085928
RAILROAD MEDICARE
—
Enumeration date
02/16/2011
Last updated
04/22/2013
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