Provider Demographics
NPI:1396737128
Name:TENNESSEE ORTHOPEDICS PT CLINIC
Entity type:Organization
Organization Name:TENNESSEE ORTHOPEDICS PT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERONE
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:615-449-0990
Mailing Address - Street 1:1616 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3100
Mailing Address - Country:US
Mailing Address - Phone:615-449-0990
Mailing Address - Fax:615-449-0970
Practice Address - Street 1:1018 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3302
Practice Address - Country:US
Practice Address - Phone:615-466-5200
Practice Address - Fax:615-466-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717761Medicaid
TN3717761Medicaid
TN5241030002Medicare NSC