Basic Information
| Provider Information | |||||||||
| NPI: | 1184655284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEUTIC SERVICES OF MORRISTOWN INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5250 W. ANDREW JOHNSON HWY. | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378141027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233187800 | ||||||||
| FaxNumber: | 4233173332 | ||||||||
| Practice Location | |||||||||
| Address1: | 5250 W. ANDREW JOHNSON HWY. | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378141027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237484800 | ||||||||
| FaxNumber: | 4233173332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAN | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4237484800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OTR L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | TN | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | OT00573 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3735744 | 05 | TN | MEDICAID |