MEDICARE: FELLOWSHIP PHYSICAL THERAPY 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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1841977956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FELLOWSHIP PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2120 S ROAN ST STE 105
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7675
Country	:	US
Telephone Number	:	423-788-4636
Fax Number	:	423-558-0011

Provider Business Practice Location Address
First Line	:	2120 S ROAN ST STE 105
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-7675
Country	:	US
Telephone Number	:	423-788-4636
Fax Number	:	423-558-0011

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	ALAN C BUNGER
Credential	:	PT
Telephone Number	:	423-788-4636

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	11/08/2024

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