MEDICARE: RIVER VALLEY PHYSICAL THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	2223	TN

General Provider Information

NPI Number	:	1891093738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER VALLEY PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	77 E LAKE ST
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-2019
Country	:	US
Telephone Number	:	731-584-0942
Fax Number	:	731-548-0942

Provider Business Practice Location Address
First Line	:	77 E LAKE ST
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-2019
Country	:	US
Telephone Number	:	731-584-0942
Fax Number	:	731-548-0942

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHEAL EUGENE BOGARD
Credential	:	PT
Telephone Number	:	731-584-0942

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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Directions to “RIVER VALLEY PHYSICAL THERAPY ” Practice Location

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