Organization
PHYSICAL REHAB INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS H GORE (OWNER)
(615) 366-6090
Entity
Organization
Contact information
Practice address
1451 ELM HILL PIKE, SUITE 100, NASHVILLE, TN 37210-4523
(615) 366-6090
(615) 366-6098
Mailing address
1451 ELM HILL PIKE, SUITE 100, NASHVILLE, TN 37210-4523
(615) 366-6090
(615) 366-6098
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3723757
—
TN
01
—
4093171
TENNCARE
TN
01
—
4118977
TENNCARE (PHYLLIS)
TN
Enumeration date
01/09/2006
Last updated
08/22/2020
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