Healthcare Provider Details

I. General information

NPI: 1164474342
Provider Name (Legal Business Name): INDEPENDENT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SCENIC HWY SUITE B
LOOKOUT MOUNTAIN TN
37350-1471
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-825-1393
  • Fax: 423-825-6147
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. TROY BAGE
Title or Position: PRESIDENT
Credential:
Phone: 423-238-7217