Healthcare Provider Details

I. General information

NPI: 1063133593
Provider Name (Legal Business Name): MEMPHIS TIME OUT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 HACKS CROSS RD STE 104
MEMPHIS TN
38125-8945
US

IV. Provider business mailing address

3285 HACKS CROSS RD STE 104
MEMPHIS TN
38125-8945
US

V. Phone/Fax

Practice location:
  • Phone: 901-484-8537
  • Fax:
Mailing address:
  • Phone: 901-484-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AHMED ALAINA
Title or Position: OWNER
Credential: DPT
Phone: 901-484-8537