Provider Demographics
NPI:1548703283
Name:BARTLETT NEUROREHAB PHYSICAL THERAPY
Entity type:Organization
Organization Name:BARTLETT NEUROREHAB PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-359-2569
Mailing Address - Street 1:7895 STAGE HILLS BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4049
Mailing Address - Country:US
Mailing Address - Phone:901-590-2379
Mailing Address - Fax:
Practice Address - Street 1:7895 STAGE HILLS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4049
Practice Address - Country:US
Practice Address - Phone:901-359-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty