Provider Demographics
NPI:1396750071
Name:PHYSIOPLUS LLC
Entity type:Organization
Organization Name:PHYSIOPLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-767-3667
Mailing Address - Street 1:756 RIDGE LAKE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9420
Mailing Address - Country:US
Mailing Address - Phone:901-767-3667
Mailing Address - Fax:901-767-3669
Practice Address - Street 1:756 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9420
Practice Address - Country:US
Practice Address - Phone:901-767-3667
Practice Address - Fax:901-767-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730201Medicare ID - Type Unspecified