Healthcare Provider Details

I. General information

NPI: 1013302777
Provider Name (Legal Business Name): NULIFE PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N BROADWAY STE B
PORTLAND TN
37148-1750
US

IV. Provider business mailing address

421 N BROADWAY STE B
PORTLAND TN
37148-1750
US

V. Phone/Fax

Practice location:
  • Phone: 615-325-9007
  • Fax: 615-325-5794
Mailing address:
  • Phone: 615-325-9007
  • Fax: 615-325-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number1241
License Number StateTN

VIII. Authorized Official

Name: LESLIE RICHARD FLATT
Title or Position: OWMER
Credential: PTA
Phone: 615-325-9007