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General NPI Number Information
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NPI Number | 1114905643
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Entity Type | Organization
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Legal Business Name | BENTON COUNTY PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 543 HIGHWAY 79
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City | DOVER
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State | TN
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Zip | 37058-5966
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Country | US
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Telephone | 931-232-0057
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Fax | 931-232-0067
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Provider Business Mailing Address
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Address Line | P.O. BOX 465
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City | PARIS
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State | TN
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Zip | 38242
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Country | US
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Telephone | 931-232-0057
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Fax | 931-232-0067
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Authorized Official
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Title or Position | CORPORATE SECRETARY/OFFICE MANAGER
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Name | MRS. DEBRA JEAN PINION
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Credential |
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Telephone | 931-232-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT2294
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0000002294
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License Number State | TN
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