NPIMap

Organization Active NPI

Nulife Physical Therapy Inc.

Doing business as NuLife Physical Therapy

  • Physical Therapy Clinic/Center
  • Portland, TN
National Provider Identifier
1013302777
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
NULIFE PHYSICAL THERAPY INC.
Doing business as
NuLife Physical Therapy
Practice address
421 N Broadway Ste B
Portland, TN 37148-1750
Phone
(615) 325-9007
Fax
(615) 325-5794
NPI assigned
Mar 31, 2015
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leslie Richard Flatt, PTANPI 1780361444
Title
Owmer
Phone
(615) 325-9007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 1241 TN

Addresses

Primary practice location

421 N Broadway Ste B
Portland, TN 37148-1750

Mailing address

421 N Broadway Ste B
Portland, TN 37148-1750
Phone (615) 325-9007

Other names 1

  • NuLife Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151007001050 TN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608187497 Receives reassigned benefits from 3 practitioners
Practice locations: Portland, TN; Westmoreland, TN

National Provider Directory

National Provider Directory
Tax ID family
Nulife Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

421 N Broadway
Ste B
Portland, TN 37148
Phone (615) 325-9007

12124 Highway 52 W
Ste D
Westmoreland, TN 37186
Phone (615) 639-0901

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1013302777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 N BROADWAY STE B",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481750",
            "telephone_number": "615-325-9007",
            "fax_number": "615-325-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N BROADWAY STE B",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481750",
            "telephone_number": "615-325-9007",
            "fax_number": "615-325-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NULIFE PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-31",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "FLATT",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWMER",
        "authorized_official_telephone_number": "615-325-9007",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "TN",
            "license": "1241",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NuLife Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.