MEDICARE: EXTRA EFFORT THERAPEUTIC SERVICES, 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	5455	TN
2	225100000X	Physical Therapist
3	225XP0200X	Pediatric Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	2251P0200X	Pediatric Physical Therapist	5455	TN

General Provider Information

NPI Number	:	1568840007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTRA EFFORT THERAPEUTIC SERVICES, LLC.

Provider Business Mailing Address
First Line	:	7361 ABERCROMBIE LN
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8947
Country	:	US
Telephone Number	:	901-240-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 ABERCROMBIE LN
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8947
Country	:	US
Telephone Number	:	901-240-6694
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMARA L JONES
Credential	:	PT, MS, ATP
Telephone Number	:	901-240-6694

Provider Enumeration Date	:	05/17/2015
Last Update Date	:	03/11/2023

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