NPIMap

Organization Active NPI

Independent Physical Therapy

  • Physical Therapist
  • Mount Juliet, TN
National Provider Identifier
1770020240
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
INDEPENDENT PHYSICAL THERAPY
Practice address
545 N Mount Juliet Rd
Ste 1101
Mount Juliet, TN 37122-4416
Phone
(615) 553-4645
Fax
(615) 553-4794
NPI assigned
Jan 23, 2017
Last updated
Jan 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

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

Authorized official

Name
Kevin Johanneson
Title
VP Revenue Cycle
Phone
(423) 238-3220

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

545 N Mount Juliet Rd
Ste 1101
Mount Juliet, TN 37122-4416

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511

Other names 1

  • Benchmark PT - Mount Juliet Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Tax ID family
Independent Physical Therapy LLC98 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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": "1485129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1770020240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 N MOUNT JULIET RD",
            "address_2": "STE 1101",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371224416",
            "telephone_number": "615-553-4645",
            "fax_number": "615-553-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-23",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "423-238-3220"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benchmark PT - Mount Juliet",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; 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.