=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396817383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2158 NORTHGATE PARK LANE SUITE 102
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37415-6958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-870-6004
-----------------------------------------------------
Fax | 423-870-6005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2158 NORTHGATE PARK LANE SUITE 102
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37415-6958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-870-6004
-----------------------------------------------------
Fax | 423-870-6005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CATHERINE L THAXTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-870-6004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------