=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083121370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2018
-----------------------------------------------------
Last Update Date | 08/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1106 S ROANE ST
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37748-7419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-234-8911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1106 S ROANE ST
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37748-7419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-234-8911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JON CHRISTOPHER ROBINSON
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 865-234-8911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------