Healthcare Provider Details

I. General information

NPI: 1033353727
Provider Name (Legal Business Name): URBAN PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W MAIN ST
LEBANON TN
37087-3460
US

IV. Provider business mailing address

521 W MAIN ST
LEBANON TN
37087-3460
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-9400
  • Fax: 615-444-9406
Mailing address:
  • Phone: 615-444-9400
  • Fax: 615-444-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OLEG URBAN
Title or Position: PRESIDENT
Credential: PT
Phone: 615-444-9400