Provider Demographics
NPI:1548457823
Name:HANS C HUMBERGER
Entity type:Organization
Organization Name:HANS C HUMBERGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-855-0745
Mailing Address - Street 1:2255 CENTER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2500
Mailing Address - Country:US
Mailing Address - Phone:423-855-0745
Mailing Address - Fax:423-855-7898
Practice Address - Street 1:2255 CENTER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2500
Practice Address - Country:US
Practice Address - Phone:423-855-0745
Practice Address - Fax:423-855-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729476Medicare PIN