Sequatchie Valley Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SEQUATCHIE VALLEY PHYSICAL THERAPY, LLC

Practice address

17919 Rankin Ave
Suite G
Dunlap, TN 37327-7040

Phone

(423) 949-7899

Fax

(423) 949-3416

NPI assigned

Oct 9, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Tommy G. Haupert, MPT, MSNPI 1649348053

Title

Chief Operating Officer

Phone

(423) 949-7899

Specialties & licenses 1

Addresses

Other names 1

• Omni Rehab, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 446694

Legal name

OMNI REHAB

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jan 28, 2008

Last certification

Jan 6, 2020

Ownership / control type

Proprietary

Facility address

17919 Rankin Avenue Suite G
Dunlap, TN 37327

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tommy Haupert, P.T.

  • Physical Therapist
  • Dunlap, TN
  • NPI 1649348053
  NPD (past) Authorized official
• Destiny Kassner, MS, OTR/L

  • Occupational Therapist
  • Dunlap, TN
  • NPI 1245180546
  NPD (past)
• Carly Jordan Payne, PT, DPT

  • Physical Therapist
  • Dunlap, TN
  • NPI 1700562691
  NPD (past)
• Sarah Roberson, MS, OTR/L

  • Occupational Therapist
  • Dunlap, TN
  • NPI 1285271783
  NPD (past)
• Ashley Louise Shockley, MOT, OTR/L

  • Occupational Therapist
  • Dunlap, TN
  • NPI 1285474999
  NPD (past)
• Barry Travis Smith, PT, ATC

  • Physical Therapist
  • Dunlap, TN
  • NPI 1417040312
  NPD (past)

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367798400000",
    "number": "1073701751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 373",
            "city": "PIKEVILLE",
            "state": "TN",
            "postal_code": "373670373",
            "telephone_number": "423-949-7899",
            "fax_number": "423-949-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17919 RANKIN AVE",
            "address_2": "SUITE G",
            "city": "DUNLAP",
            "state": "TN",
            "postal_code": "373277040",
            "telephone_number": "423-949-7899",
            "fax_number": "423-949-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUATCHIE VALLEY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2013-05-06",
        "status": "A",
        "authorized_official_last_name": "HAUPERT",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "423-949-7899",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, MS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Rehab, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Roberson, MS, OTR/L
• Brittney Collette Roberts, RN
• Courtney R Robertson, NP
• Oscar Dewitt Scruggs IV, DDS
• Sequatchie County Board of Education
• Jessica Dion Shedd, NP-C
• Karen Shepherd, D.O.
• Ashley Louise Shockley, MOT, OTR/L
• Sydney Shoulders
• Barry Travis Smith, PT, ATC

• Physical Therapist in Dunlap, TN
• Providers in Dunlap, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.