Basic Information
| Provider Information | |||||||||
| NPI: | 1811596711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESULTS-AST JV, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 306393 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372306393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154650922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 627 JAMES CAMPBELL BLVD, SOUTH | ||||||||
| Address2: | SUITE B | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313982288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | LANGE | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6154650922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.