Provider Demographics
NPI:1972564771
Name:PROFESSIONAL THERAPY SERVICES OF TENNESSEE, LLC
Entity type:Organization
Organization Name:PROFESSIONAL THERAPY SERVICES OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-570-0911
Mailing Address - Street 1:8301B DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4202
Mailing Address - Country:US
Mailing Address - Phone:423-843-1014
Mailing Address - Fax:423-843-1016
Practice Address - Street 1:8301B DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4202
Practice Address - Country:US
Practice Address - Phone:423-843-1014
Practice Address - Fax:423-843-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
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
TN446669Medicare ID - Type Unspecified