Organization
OCOEE PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS LEE PETERSON PT, CHT (PRESIDENT)
(423) 559-1537
Entity
Organization
Contact information
Practice address
3112 OCOEE ST N, CLEVELAND, TN 37312-5382
(423) 559-1537
(423) 559-1539
Mailing address
3112 OCOEE ST N, CLEVELAND, TN 37312-5382
(423) 559-1537
(423) 559-1539
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192907
TENNCARE ID NUMBER
TN
05
—
3651441
—
TN
01
—
686135
ACN ID NUMBER
TN
Enumeration date
07/06/2006
Last updated
03/15/2011
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