MEDICARE: INDEPENDENT PHYSICAL THERAPY LLC

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	:	1932613775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 SHADY BROOK ST STE 3
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3993
Country	:	US
Telephone Number	:	931-388-8500
Fax Number	:	931-388-8526

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-2330

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	11/30/2017

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Directions to “INDEPENDENT PHYSICAL THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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