MEDICARE: MRS. ELLEN STANPHILL CLINE P.T.

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	5993	TN

General Provider Information

NPI Number	:	1396952461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN STANPHILL CLINE P.T.

Provider Business Mailing Address
First Line	:	1 SISKIN PLAZA
Second Line	:	SISKIN HOSPITAL THERAPY SERVICES WITH ERLANGER
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403
Country	:	US
Telephone Number	:	423-778-4901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 RIVERSIDE DR
Second Line	:	STE. 270
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4309
Country	:	US
Telephone Number	:	423-778-3196
Fax Number	:	423-778-6197

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/05/2007

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