MEDICARE: PHYSIOPLUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1396750071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOPLUS LLC

Provider Business Mailing Address
First Line	:	756 RIDGE LAKE BLVD
Second Line	:	SUITE 205
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9420
Country	:	US
Telephone Number	:	901-767-3667
Fax Number	:	901-767-3669

Provider Business Practice Location Address
First Line	:	756 RIDGE LAKE BLVD
Second Line	:	SUITE 205
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9420
Country	:	US
Telephone Number	:	901-767-3667
Fax Number	:	901-767-3669

Authorized Official
Title or Position	:	CHIEF MANAGER
Name	:	MR. CARL ANDREW HENDERSON
Credential	:	P.T.
Telephone Number	:	901-767-3667

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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Directions to “PHYSIOPLUS LLC ” Practice Location

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