Organization
ADVANCED PHYSIOTHERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DREW RANDOLPH DPT, OCS (OWNER/MANAGER- PHYSICAL THERAPIST)
(931) 319-2763
Entity
Organization
Contact information
Practice address
4120 BRADFORD HICKS DR, SUITE A, LIVINGSTON, TN 38570-2213
(931) 403-2040
(931) 403-2041
Mailing address
705 E HUDGENS ST APT A, COOKEVILLE, TN 38501-4564
(931) 403-2040
(931) 403-2041
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
8634
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01379040
—
TN
Enumeration date
09/22/2016
Last updated
10/18/2016
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