Provider Demographics
NPI:1285771527
Name:COLONIAL HEIGHTS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:COLONIAL HEIGHTS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAST
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:423-239-5774
Mailing Address - Street 1:PO BOX 6182
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-1182
Mailing Address - Country:US
Mailing Address - Phone:423-239-5774
Mailing Address - Fax:423-239-5975
Practice Address - Street 1:5334 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3729
Practice Address - Country:US
Practice Address - Phone:423-239-5774
Practice Address - Fax:423-239-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty