Organization
904 THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN C BLCAK (PRESIDENT)
(423) 258-2264
Entity
Organization
Contact information
Practice address
900 W MAIN ST, ROGERSVILLE, TN 37857-2448
(423) 500-5600
(423) 373-1351
Mailing address
2800 N 6TH ST UNIT 1, SAINT AUGUSTINE, FL 32084-1886
(423) 317-7772
(423) 373-1351
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
04/06/2022
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