Independent Physical Therapy
Organization Active NPI Physical Therapy Clinic/Center · Kodak, TN
NPI 1275933384 · NPPES record last updated Aug 26, 2014
Key facts
- NPI
- 1275933384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- INDEPENDENT PHYSICAL THERAPY
- Practice address
- 2946 Winfield Dunn Pkwy Ste 106
Kodak, TN 37764-4318 - Phone
- (865) 932-1088
- Fax
- (865) 932-1454
- NPI assigned
- Aug 26, 2014
- Organization subpart
- No
Authorized official
- Name
- Lisa Benetto
- Title
- Credentialing Manager
- Phone
- (423) 238-8923
Corporate family (same tax ID) 24
Practitioners 3
-
Alexi Gordon, DPT
-
Darin R. Payne, P.T., D.P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040928000202 | TN | Part B Supplier - Clinic/Group Practice | 9335056308 |
Receives reassigned benefits from 324 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Independent Physical Therapy LLC
Locations
1480 E 3rd St
Chattanooga, TN 37404
Phone (423) 622-2459
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Yes | ||
| Occupational Medicine Clinic/Center | 261QX0100X |
Addresses
Primary practice location
2946 Winfield Dunn Pkwy Ste 106
Kodak, TN 37764-4318
Mailing address
8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217
Other names
- BENCHMARK PHYSICAL THERAPY
Other providers in Kodak, TN
- Virginia Hawley
- Healthpathways TN, LLC
- Janice Hendrix
- Claudia Renee Hirsemann
- Bailey Miles Holder
- Matthew Johnson
- K VA T Food Stores Inc
- Kodak Family Dental, PLLC
- Joseph Laznik
- Doreen Georgina Leo-Huneke
All providers in Kodak, TN · Physical Therapy Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.