Provider Demographics
NPI:1912310533
Name:PRIMARY THERAPY SERVICES LLC
Entity type:Organization
Organization Name:PRIMARY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DISMUKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:615-594-1075
Mailing Address - Street 1:601 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4179
Mailing Address - Country:US
Mailing Address - Phone:615-594-1075
Mailing Address - Fax:615-220-2358
Practice Address - Street 1:601 WOODHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-594-1075
Practice Address - Fax:615-220-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3072251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health