Healthcare Provider Details

I. General information

NPI: 1568840007
Provider Name (Legal Business Name): EXTRA EFFORT THERAPEUTIC SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7361 ABERCROMBIE LN
MEMPHIS TN
38119-8947
US

IV. Provider business mailing address

7361 ABERCROMBIE LN
MEMPHIS TN
38119-8947
US

V. Phone/Fax

Practice location:
  • Phone: 901-240-6694
  • Fax:
Mailing address:
  • Phone: 901-240-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5455
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5455
License Number StateTN

VIII. Authorized Official

Name: TAMARA L JONES
Title or Position: OWNER
Credential: PT, MS, ATP
Phone: 901-240-6694