Individual
AMY MARIE PERALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2304 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5316
(865) 980-6000
Mailing address
912 SW CROSS RD, MARYVILLE, TN 37803-7532
(615) 613-2056
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3907
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-1632255
EMPLOYEER
TN
Enumeration date
01/12/2019
Last updated
01/12/2019
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