MEDICARE: DR. LUISA P LONG PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14075	TN
2	225100000X	Physical Therapist	10533	CO

General Provider Information

NPI Number	:	1043543705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUISA P LONG PT, DPT

Provider Business Mailing Address
First Line	:	6600 STAGE RD STE 129
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3838
Country	:	US
Telephone Number	:	901-866-9239
Fax Number	:	901-654-3288

Provider Business Practice Location Address
First Line	:	2961 CANADA RD STE 107
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-4893
Country	:	US
Telephone Number	:	901-866-9239
Fax Number	:	901-654-3288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/27/2024

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