Organization
INDEPENDENT PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-2330
Entity
Organization
Contact information
Practice address
1810 SHADY BROOK ST STE 3, COLUMBIA, TN 38401-3993
(931) 388-8500
(931) 388-8526
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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