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Organization
SPORT MED PHYSICAL THERAPY
Active
Organization
SPORT MED PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLAN E VALENZUELA PT (OWNER)
(423) 304-2879
Entity
Organization
Contact information
Practice address
212 EAST MAIN ST, MONTEAGLE, TN 37356
(423) 240-0512
Mailing address
PO BOX 1092, MONTEAGLE, TN 37356-1092
(423) 240-0512
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2178
TN
Other
Enumeration date
02/20/2009
Last updated
02/20/2009
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