| Organization Name: | INDEPENDENT PHYSICAL THERAPY |
| NPI Number: | 1275933384 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA BENETTO (CREDENTIALING MANAGER) |
| Mailing Address: | 2946 Winfield Dunn Pkwy Ste 106 Kodak |
| State: | TN US |
| Postal Code: | 377644318 |
| Phone Number: | 8659321088 |
| Fax Number: | 8659321454 |
| NPI Enumeration Date: | 08/26/2014 |
| NPI Last Update Date: | 08/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |