| NPI | 1295370948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BENETTO Mgr Provider Enrollment 423-238-8923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2019-11-15 |