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NPI Code Detail

MEDICARE: BENCHMARK PHYSICAL THERAPY OF NC, LLC

MEDICARE: BENCHMARK PHYSICAL THERAPY OF NC, LLC
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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1205346699
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENCHMARK PHYSICAL THERAPY OF NC, LLC
Provider Business Mailing Address
First Line : 6397 LEE HWY STE 300
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-2564
Country : US
Telephone Number : 423-238-7212
Fax Number : 423-238-3473
Provider Business Practice Location Address
First Line : 5619 CAROLINA BEACH RD STE 120
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2815
Country : US
Telephone Number : 123-456-7890
Fax Number :
Authorized Official
Title or Position : VP REVENUE CYCLE
Name : KEVIN JOHANNESON
Credential :
Telephone Number : 423-238-2330
Provider Enumeration Date : 10/11/2017
Last Update Date : 10/11/2017

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Directions to “BENCHMARK PHYSICAL THERAPY OF NC, LLC ” Practice Location

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