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Organization
SOUTHERN PHYSICAL THERAPY, LLC
Active
Organization
SOUTHERN PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JOHN MASTALERZ PT, ATC (OWNER/ADMINISTRATOR)
(931) 388-8500
Entity
Organization
Contact information
Practice address
1810 SHADY BROOK ST, SUITE 3, COLUMBIA, TN 38401-3993
(931) 388-8500
Mailing address
1810 SHADY BROOK ST, SUITE 3, COLUMBIA, TN 38401-3993
(931) 388-8500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2044
TN
225100000X
Physical Therapist
PT6832
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3723207
—
TN
Enumeration date
10/25/2006
Last updated
02/23/2015
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