Basic Information
| Provider Information | |||||||||
| NPI: | 1962697789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIPMAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017258347 | ||||||||
| FaxNumber: | 9012597637 | ||||||||
| Practice Location | |||||||||
| Address1: | 6286 BRIARCREST AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381204023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016413000 | ||||||||
| FaxNumber: | 9012591698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2007 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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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 | 7764 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 620819926 | 01 | TN | CIGNA | OTHER | 110318002 | 05 | AR | MEDICAID | 4164332 | 01 | TN | BCBS | OTHER | 620819926 | 01 | TN | TRICARE | OTHER | 620819926 | 01 | MS | BCBS | OTHER | 7187860 | 05 | MS | MEDICAID | 9645091 | 01 | TN | AETNA | OTHER | 3371161 | 05 | TN | MEDICAID | 06031726 | 05 | MS | MEDICAID | 1512617 | 05 | TN | MEDICAID | 0723280001 | 01 | TN | PALMETTO | OTHER | 620819926 | 01 | TN | AETNA | OTHER |