Organization Name: | INDEPENDENT PHYSICAL THERAPY |
NPI Number: | 1710154406 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TROY BAGE (PRESIDENT) |
Mailing Address: | 1467 N Mack Smith Rd East Ridge |
State: | TN US |
Postal Code: | 374123947 |
Phone Number: | 4238944403 |
Fax Number: | 4238944513 |
NPI Enumeration Date: | 05/12/2008 |
NPI Last Update Date: | 06/24/2010 |
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: |