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General NPI Number Information
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NPI Number | 1043766975
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Entity Type | Organization
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Legal Business Name | ATHLETIC EDGE PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1440 ADAMS ST STE A
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City | CHATTANOOGA
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State | TN
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Zip | 37408
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Country | US
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Telephone | 423-402-0778
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Fax | 186-633-4026
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | CHATTANOOGA
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State | TN
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Zip | 37401-1132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. BRANDON TYLER WHITWORTH
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Credential | DPT
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Telephone | 631-790-9798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 10299
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License Number State | TN
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