Organization
INDEPENDENT PHYSICAL THERPAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-8923
Entity
Organization
Contact information
Practice address
642 HIGHWAY 76, WHITE HOUSE, TN 37188-9205
(615) 672-4966
(615) 672-4968
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/08/2015
Last updated
09/03/2020
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