Basic Information
| Provider Information | |||||||||
| NPI: | 1508869462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RISINGER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | BROOKS | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 MALLORY LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370678233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153739461 | ||||||||
| FaxNumber: | 6152219054 | ||||||||
| Practice Location | |||||||||
| Address1: | 3964 GOODMAN RD E | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386728761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628906953 | ||||||||
| FaxNumber: | 6628906954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5427 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 620819926 | 01 | MS | BCBS | OTHER | 620819926 | 01 | TN | AETNA | OTHER | P00266256 | 01 | TN | RAILROAD MEDICARE | OTHER | 4041683 | 01 | TN | BCBS | OTHER | 0723280001 | 01 | TN | PALMETTO | OTHER |