Basic Information
| Provider Information | |||||||||
| NPI: | 1063605491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANKLIN REHAB CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2511 WESLEY ST | ||||||||
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| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376011723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239523050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2511 WESLEY ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376011723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239523050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | SPADY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4239523050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 19387 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.