Organization
INDEPENDENT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-8923
Entity
Organization
Contact information
Practice address
320 E MAIN ST STE 100, CHATTANOOGA, TN 37408-1533
(423) 238-8923
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-8923
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/28/2015
Last updated
07/28/2015
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