Provider Demographics
NPI:1902143308
Name:INDEPENDENT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY
Other - Org Name:BENCHMARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR- CONTRACT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-238-7217
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:323 SAM RIDLEY PKWY W
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5625
Practice Address - Country:US
Practice Address - Phone:615-751-5211
Practice Address - Fax:615-751-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine