Provider Demographics
NPI:1730736323
Name:MUTH, REBECCA THOMS (MPT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:THOMS
Last Name:MUTH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 SAINT PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9450
Mailing Address - Country:US
Mailing Address - Phone:225-921-5461
Mailing Address - Fax:
Practice Address - Street 1:2317 US HIGHWAY 411 S
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-8634
Practice Address - Country:US
Practice Address - Phone:865-238-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty