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General NPI Number Information
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NPI Number | 1841977956
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Entity Type | Organization
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Legal Business Name | FELLOWSHIP PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2120 S ROAN ST STE 105
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City | JOHNSON CITY
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State | TN
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Zip | 37601-7675
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Country | US
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Telephone | 423-788-4636
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Fax | 423-558-0011
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Provider Business Mailing Address
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Address Line | 2120 S ROAN ST STE 105
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City | JOHNSON CITY
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State | TN
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Zip | 37601-7675
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Country | US
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Telephone | 423-788-4636
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Fax | 423-558-0011
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | ALAN C BUNGER
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Credential | PT
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Telephone | 423-788-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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