MEDICARE: PHYSICAL THERAPY ALLIANCE, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1497785216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY ALLIANCE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 682446
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-2446
Country	:	US
Telephone Number	:	615-591-6590
Fax Number	:	615-591-6601

Provider Business Practice Location Address
First Line	:	6610 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3045
Country	:	US
Telephone Number	:	502-762-1243
Fax Number	:	502-762-9114

Authorized Official
Title or Position	:	A/R DIRECTOR
Name	:	DONNA DILWORTH
Credential	:
Telephone Number	:	615-591-6590

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/10/2013

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