Organization
LBA MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH WELLMAN RN (ADMINISTRATOR)
(423) 775-0771
Entity
Organization
Contact information
Practice address
200 SANITARIUM CIRCLE, DAYTON, TN 37321
(423) 775-0771
(423) 834-9059
Mailing address
114 CAMPUS DR, DAYTON, TN 37321
(423) 775-3336
(423) 775-6052
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT000008620
TN
225X00000X
Occupational Therapist
OT000004463
TN
Other
Enumeration date
12/20/2011
Last updated
03/15/2017
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