Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Joel Dudley

Individual provider Physical Therapist · NPI 1750964284

Ethan Joel Dudley is a Physical Therapist in Private Practice in Maryville, Tennessee. Qualified in 2021, 5 years ago. Practices with Agilitas USA, Inc, a 810-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
5
Licensed in
TN
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

1632 W Broadway Ave
Maryville, TN 37801-5600
Phone: (865) 984-1996
Fax: (865) 984-1997
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 13412 (TN)
Physical Therapist Taxonomy 225100000X (TN)

Record details

NPI number1750964284
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 3, 2021
Last updated in NPPESMay 26, 2021
Certification dateMay 26, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Agilitas Usa, Inc — 810 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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