Healthcare Provider Details

I. General information

NPI: 1831308147
Provider Name (Legal Business Name): ERWIN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N MAIN AVE
ERWIN TN
37650-9168
US

IV. Provider business mailing address

PO BOX 5748
JOHNSON CITY TN
37602-5748
US

V. Phone/Fax

Practice location:
  • Phone: 423-854-0001
  • Fax: 423-854-0002
Mailing address:
  • Phone: 423-854-0001
  • Fax: 423-854-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPT0000003577
License Number StateTN

VIII. Authorized Official

Name: FRANCISCO E BORQUEZ
Title or Position: OWNER
Credential: PT
Phone: 423-854-0001