MEDICARE: ONMARK PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center
3	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1689930513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONMARK PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-8923
Fax Number	:	423-238-3222

Provider Business Practice Location Address
First Line	:	2345 MOODY PKWY STE 206
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3039
Country	:	US
Telephone Number	:	205-640-4881
Fax Number	:	205-640-4882

Authorized Official
Title or Position	:	PAYOR RELATIONS COORDINATOR
Name	:	KILEY RUSSELL
Credential	:
Telephone Number	:	423-238-8923

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/05/2012

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Directions to “ONMARK PHYSICAL THERAPY, LLC ” Practice Location

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