Provider Demographics
NPI:1528064193
Name:FUSION FITNESS & PHYSICAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:FUSION FITNESS & PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, DIR OF PHYSICAL THER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CSCI
Authorized Official - Phone:423-267-9146
Mailing Address - Street 1:626 CHEROKEE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3302
Mailing Address - Country:US
Mailing Address - Phone:423-267-9146
Mailing Address - Fax:423-267-9081
Practice Address - Street 1:626 CHEROKEE BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3302
Practice Address - Country:US
Practice Address - Phone:423-267-9146
Practice Address - Fax:423-267-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446674Medicaid
TN0446674Medicaid