MEDICARE: INDEPENDENT PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376060269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6736 CHARLOTTE PIKE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4290
Country	:	US
Telephone Number	:	888-780-0279
Fax Number	:	888-780-0293

Authorized Official
Title or Position	:	VP REVNUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-3220

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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Directions to “INDEPENDENT PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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