Basic Information
| Provider Information | |||||||||
| NPI: | 1083652184 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSIOTHERAPY ASSOCIATES INC | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | PHYSIOTHERAPY ASSOCIATES-CROSSVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4714 GETTYSBURG RD | ||||||||
| Address2: | LEGAL DEPARTMENT | ||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170554325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179721100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 118 BROWN AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385557740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314566608 | ||||||||
| FaxNumber: | 9314566673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TARVIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND SECREATARY | ||||||||
| AuthorizedOfficialTelephone: | 7179721100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0446557 | 05 | TN | MEDICAID | 4093294 | 01 | TN | BLUECROSS/BLUESHIELD/TN | OTHER | 5186150 | 01 | TN | AETNA | OTHER | 0626451 | 01 | TN | CIGNA | OTHER | 644001 | 01 | TN | UNITED HEALTHCARE | OTHER |