Organization
INDEPENDENT PHYSICAL THERAPY, LLC
Active
Other names
BENCHMARK PT
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-8923
Entity
Organization
Contact information
Practice address
1904 W BROADWAY AVE, MARYVILLE, TN 37801-5402
(865) 983-8129
(865) 983-8293
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3417
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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