Provider Demographics
NPI:1427382027
Name:TATE, JEREMIAH J (PT)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:J
Last Name:TATE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MEADOW VIEW RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1725
Mailing Address - Country:US
Mailing Address - Phone:423-844-6935
Mailing Address - Fax:423-844-6937
Practice Address - Street 1:105 MEADOW VIEW RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1725
Practice Address - Country:US
Practice Address - Phone:423-844-6935
Practice Address - Fax:423-844-6937
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000059942251X0800X
TN5994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I652884Medicaid
TN1517092Medicaid
TN103I652884Medicare PIN