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General NPI Number Information
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NPI Number | 1912310533
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Entity Type | Organization
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Legal Business Name | PRIMARY THERAPY SERVICES LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 601 WOODHAVEN DRIVE
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City | SMYRNA
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State | TN
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Zip | 37167
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Country | US
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Telephone | 615-594-1075
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Fax | 615-220-2358
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Provider Business Mailing Address
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Address Line | 601 WOODHAVEN DR
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City | SMYRNA
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State | TN
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Zip | 37167-4179
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Country | US
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Telephone | 615-594-1075
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Fax | 615-220-2358
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Authorized Official
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Title or Position | CEO
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Name | ERNEST EDWARD DISMUKE JR.
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Credential | OTR/L
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Telephone | 615-594-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3072
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License Number State | TN
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