Organization
IMPACT PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MAYNARD (OFFICE MANAGER)
(615) 453-1422
Entity
Organization
Contact information
Practice address
7295 SPARTA PIKE, WATERTOWN, TN 37184
(615) 697-2005
(615) 697-2078
Mailing address
1430 W BADDOUR PKWY STE C, LEBANON, TN 37087-2656
(615) 453-1422
(615) 453-1429
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1502771
—
TN
Enumeration date
01/31/2019
Last updated
05/12/2023
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