Healthcare Provider Details

I. General information

NPI: 1083873657
Provider Name (Legal Business Name): TOTAL THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2008
Last Update Date: 06/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HIGHWAY 64 E
WAYNESBORO TN
38485-3018
US

IV. Provider business mailing address

PO BOX 808
WAYNESBORO TN
38485-0808
US

V. Phone/Fax

Practice location:
  • Phone: 931-231-5483
  • Fax:
Mailing address:
  • Phone: 931-231-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN DAVID BRISON
Title or Position: CO-OWNER
Credential:
Phone: 931-724-6337