Impact Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

IMPACT PHYSICAL THERAPY LLC

Practice address

7295 Sparta Pike
Watertown, TN 37184

Phone

(615) 697-2005

Fax

(615) 697-2078

NPI assigned

Jan 31, 2019

Last updated

May 12, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kim Maynard

Title

Office Manager

Phone

(615) 453-1422

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Impact Physical Therapy, LLC

  • Physical Therapist
  • Lebanon, TN
  • NPI 1174709430

  O20080417000691

  Same enrollment

Tax ID family

Impact 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.

• Impact Physical Therapy, LLC

  • Physical Therapist
  • Lebanon, TN
  • NPI 1174709430
  NPD tax ID

Locations

Practitioners 6

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.

• Angela L Barham, PT

  • Physical Therapist
  • Nashville, TN
  • NPI 1538471164
  NPD
• John R Boucher, P.T.

  • Physical Therapist
  • Lebanon, TN
  • NPI 1457371718
  NPD
• Chandelle Lanier-Hackett, PT

  • Physical Therapist
  • Lebanon, TN
  • NPI 1255354205
  NPD
• Anthony Weerts

  • Physical Therapist
  • Murfreesboro, TN
  • NPI 1649383589
  NPD
• Carmen Yvonne Williams, PT

  • Physical Therapist
  • Mount Juliet, TN
  • NPI 1417129909
  NPD
• Van Huffine I, OT

  • Occupational Therapist
  • Winfield, IN
  • NPI 1043234982
  NPD

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1386109668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 W BADDOUR PKWY STE C",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872656",
            "telephone_number": "615-453-1422",
            "fax_number": "615-453-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7295 SPARTA PIKE",
            "city": "WATERTOWN",
            "state": "TN",
            "postal_code": "37184",
            "telephone_number": "615-697-2005",
            "fax_number": "615-697-2078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-453-1422"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1502771",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaime Lee Bello
• Stephanie Bess, RBT
• Developmental Journeys ABA, LLC
• Fast Pace Medical Clinic PLLC
• Stephanie Lynn Horgan, BCBA
• Terry L Jackson, DDS
• Stephanie N Kare
• Ashley Ann Mangrum, RN
• Rachel McRoberts, LPC-MHSP, NCC, RPT-S
• Calicia Jean Moss

• Physical Therapist in Watertown, TN
• Providers in Watertown, 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 12, 2023; 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.