Healthcare Provider Details

I. General information

NPI: 1851405666
Provider Name (Legal Business Name): INDEPENDENT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date: 10/22/2007
Reactivation Date: 05/27/2008

III. Provider practice location address

22024 RHEA COUNTY HWY STE 2
SPRING CITY TN
37381-5243
US

IV. Provider business mailing address

8823 PRODUCTION LANE
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-365-0515
  • Fax: 423-365-2693
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TROY BAGE
Title or Position: PRESIDENT
Credential:
Phone: 423-238-7217