Southern Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2044 Issued in TN

Legal business name

SOUTHERN PHYSICAL THERAPY, LLC

Practice address

1810 Shady Brook St
Suite 3
Columbia, TN 38401-3993

Phone

(931) 388-8500

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

William John Mastalerz, PT, ATC

Title

Owner/Administrator

Phone

(931) 388-8500

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 6

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

• Joanna Mastalerz

  • Physical Therapist
  • Columbia, TN
  • NPI 1376917914
  NPD (past)
• Ashley Ann Miller, PT

  • Physical Therapist
  • Columbia, TN
  • NPI 1952446502
  NPD (past)
• Bonnie Church Roder, P.T.

  • Physical Therapist
  • Columbia, TN
  • NPI 1053534594
  NPD (past)
• Stephanie Lee Williams, PTA

  • Physical Therapy Assistant
  • Columbia, TN
  • NPI 1376854349
  NPD (past)
• Ronald Shane Wilson, PT

  • Physical Therapist
  • Columbia, TN
  • NPI 1629150941
  NPD (past)
• Annette Lettiere, PT

  • Physical Therapist
  • Southlake, TX
  • NPI 1942335948
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1720162662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 SHADY BROOK ST",
            "address_2": "SUITE 3",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384013993",
            "telephone_number": "931-388-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 SHADY BROOK ST",
            "address_2": "SUITE 3",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384013993",
            "telephone_number": "931-388-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "MASTALERZ",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "931-388-8500",
        "authorized_official_credential": "PT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT2044",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT6832",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3723207",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick A Souris, MD
• South Central Community Services Agency
• South Central Heart Group Inc
• South Central TN Development District
• Southern Family Markets LLC
• Southern Radiology Associates, PLLC
• Southern TN Transportation
• Campbell Miller Sowell Jr., D D S
• Rebecca Sue Sowell, PHARM.D.
• David George Spak

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.