Provider Demographics
NPI:1629703210
Name:PREMIER PHYSICAL THERAPY OF SE TN
Entity type:Organization
Organization Name:PREMIER PHYSICAL THERAPY OF SE TN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-464-4884
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0923
Mailing Address - Country:US
Mailing Address - Phone:423-464-4884
Mailing Address - Fax:833-333-1455
Practice Address - Street 1:108 LIFESTYLE WAY STE 3
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-3914
Practice Address - Country:US
Practice Address - Phone:423-464-4884
Practice Address - Fax:833-333-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty