Healthcare Provider Details

I. General information

NPI: 1396789061
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16054 SCOTT COUNTY HIGHWAY
ONEIDA TN
37841
US

IV. Provider business mailing address

P.O. BOX 1245
INDIANA PA
15701-5245
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-6111
  • Fax: 423-569-6211
Mailing address:
  • Phone: 724-465-3496
  • Fax: 215-413-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP.T.5526
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP.T.A.2313
License Number StateTN

VIII. Authorized Official

Name: JAYNE FLECK POOL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 724-465-3496