Provider Demographics
NPI:1730362211
Name:CHEROKEE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:CHEROKEE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-921-8088
Mailing Address - Street 1:482 PARK BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-6927
Mailing Address - Country:US
Mailing Address - Phone:423-921-8088
Mailing Address - Fax:423-921-0046
Practice Address - Street 1:482 PARK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-6927
Practice Address - Country:US
Practice Address - Phone:423-921-8088
Practice Address - Fax:423-921-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001848261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370258Medicare PIN