Healthcare Provider Details

I. General information

NPI: 1114905643
Provider Name (Legal Business Name): BENTON COUNTY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 HIGHWAY 79
DOVER TN
37058-5966
US

IV. Provider business mailing address

P.O. BOX 465
PARIS TN
38242
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-0057
  • Fax: 931-232-0067
Mailing address:
  • Phone: 931-232-0057
  • Fax: 931-232-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000002294
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT2294
License Number StateTN

VIII. Authorized Official

Name: MRS. DEBRA JEAN PINION
Title or Position: CORPORATE SECRETARY/OFFICE MANAGER
Credential:
Phone: 931-232-0057