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General NPI Number Information
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NPI Number | 1598357683
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Entity Type | Organization
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Legal Business Name | MD PHYSICAL THERAPY CENTER FOR LONGEVITY
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 4945 BAL HARBOR DR
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City | CHATTANOOGA
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State | TN
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Zip | 37416-1714
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Country | US
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Telephone | 423-718-1627
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Fax | 423-855-1482
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Provider Business Mailing Address
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Address Line | 4945 BAL HARBOR DR
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City | CHATTANOOGA
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State | TN
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Zip | 37416-1714
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Country | US
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Telephone | 423-718-1627
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Fax | 423-855-1482
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Authorized Official
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Title or Position | AO/PT
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Name | MRS. MARION MARKETTIA DUNCAN
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Credential | PT
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Telephone | 142-371-8162
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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 |
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License Number State |
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