Organization
INDEPENDENT PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BENETTO (MANAGER PAYER & PROVIDER ENROLLMENT)
(423) 238-8923
Entity
Organization
Contact information
Practice address
900 E JACKSON BLVD STE 4, JONESBOROUGH, TN 37659-1505
(423) 218-1751
(423) 218-1752
Mailing address
1200 CORPORATE DR STE 400, BIRMINGHAM, AL 35242-5424
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
03/04/2014
Last updated
12/29/2019
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