Healthcare Provider Details

I. General information

NPI: 1154461218
Provider Name (Legal Business Name): MIDTOWN INJURY & PHYSICAL THERAPY CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 MADISON AVE
MEMPHIS TN
38104-2447
US

IV. Provider business mailing address

1488 MADISON AVE
MEMPHIS TN
38104-2447
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-4110
  • Fax: 901-726-4106
Mailing address:
  • Phone: 901-726-4110
  • Fax: 901-726-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY LEE LOVELACE
Title or Position: OWNER
Credential: M.D.
Phone: 901-726-4108