Individual
JUSTIN WAYNE HIDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7557 DANNAHER WAY, POWELL, TN 37849-3558
(865) 512-1140
Mailing address
260 FORT SANDERS WEST BLVD, KNOXVILLE, TN 37922-3355
(865) 769-4500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT8009
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508067
—
TN
01
—
3711622
MEDICARE PTAN
—
01
—
4202023
BLUECROSS BLUESHIELD
TN
Enumeration date
05/29/2008
Last updated
03/10/2009
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