Healthcare Provider Details

I. General information

NPI: 1639728793
Provider Name (Legal Business Name): FOUNDATION PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 OLD HUNTER RD
OOLTEWAH TN
37363-8815
US

IV. Provider business mailing address

5604 OLD HUNTER RD
OOLTEWAH TN
37363-8815
US

V. Phone/Fax

Practice location:
  • Phone: 423-531-4444
  • Fax: 423-531-4445
Mailing address:
  • Phone: 423-531-4444
  • Fax: 423-531-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUDITH ARANDA
Title or Position: MSPT/OWNER
Credential: PHYSICAL THERAPIST
Phone: 423-531-4444