| Organization Name: | PRESTIGE PHYSICAL THERAPY |
| NPI Number: | 1053566463 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN PAUL COGGINS (OWNER) |
| Mailing Address: | 514 S High St Waynesboro |
| State: | TN US |
| Postal Code: | 384852615 |
| Phone Number: | 9317222778 |
| Fax Number: | 9317227569 |
| NPI Enumeration Date: | 11/26/2008 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 7920 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |