Provider Demographics
NPI:1174779888
Name:KETCHUM, TROY M (PT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:M
Last Name:KETCHUM
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 1:2001 MALLORY LN
Mailing Address - Street 2:STE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:1511 GUNBARREL RD
Practice Address - Street 2:STE 115
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5050
Practice Address - Country:US
Practice Address - Phone:423-894-4188
Practice Address - Fax:423-894-4185
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07385225100000X
TN8995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist