1396817383 NPI number — PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, INC

Table of content: (NPI 1396817383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396817383 NPI number — PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, 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:
1396817383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2158 NORTHGATE PARK LANE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37415-6958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-870-6004
Provider Business Mailing Address Fax Number:
423-870-6005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2158 NORTHGATE PARK LANE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37415-6958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-870-6004
Provider Business Practice Location Address Fax Number:
423-870-6005
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THAXTON
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
423-870-6004

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 446558 . This is a "RIVERBEND GOVERNMENT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4978909 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 165334501 . This is a "ACS DEPARTMENT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3110918 . This is a "BLUECROSS BLUESHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-50537 . This is a "MEDICA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 650009038 . This is a "PALMETTO RAILROAD M'CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 94573 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3110918 . This is a "BCBS/TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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