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General NPI Number Information
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NPI Number | 1780366153
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Entity Type | Organization
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Legal Business Name | TRUE VINE THERAPY SERVICES
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 724 COPPER BRANCH RD
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City | HERMITAGE
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State | TN
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Zip | 37076-1675
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Country | US
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Telephone | 205-218-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 724 COPPER BRANCH RD
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City | HERMITAGE
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State | TN
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Zip | 37076-1675
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Country | US
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Telephone | 205-218-4723
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. MICAH STANTHONY GIVENS
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Credential | DPT
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Telephone | 205-218-4723
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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 |
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License Number State |
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