Organization
INDEPENDENT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-2313
Entity
Organization
Contact information
Practice address
612 LYLE ST STE 118, JOHNSON CITY, TN 37604-8001
(423) 328-3156
Mailing address
6397 LEE HWY STE 300, CHATTANOOOGA, TN 37421-2564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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