Individual
MS. LISA L. GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8904 CROSS PARK DR, KNOXVILLE, TN 37923-4703
(865) 690-2671
(865) 690-6445
Mailing address
PO BOX 32709, KNOXVILLE, TN 37930-2709
(865) 558-6484
(865) 584-4037
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1917
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3154494
BLUE CROSS
TN
05
—
3652046
—
TN
01
—
CH4394
MEDICARE-RAILROAD GROUP ID
TN
Enumeration date
05/17/2006
Last updated
06/09/2008
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