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General NPI Number Information
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NPI Number | 1700055977
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Entity Type | Organization
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Legal Business Name | CHATTANOOGA SPINE & SPORT
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 2307 NAPIER RD STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1827
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Country | US
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Telephone | 423-894-9893
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Fax | 423-894-0992
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Provider Business Mailing Address
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Address Line | 2307 NAPIER RD STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1827
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Country | US
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Telephone | 423-894-9893
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Fax | 423-894-0992
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Authorized Official
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Title or Position | OWNER
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Name | MR. LOREN HEATH PEREZ
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Credential | MSPT
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Telephone | 423-894-9893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0000004942
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License Number State | TN
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