1447475025 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Table of content: (NPI 1447475025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447475025 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOTHERAPY ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447475025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6263 POPLAR AVE
Provider Second Line Business Mailing Address:
SUITE 801
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-685-7227
Provider Business Mailing Address Fax Number:
267-321-2079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 POWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501-7676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-553-5332
Provider Business Practice Location Address Fax Number:
402-553-5391
Provider Enumeration Date:
04/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FITZPATRICK
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
610-644-7824

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)