Provider Demographics
NPI:1023042405
Name:101 PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:101 PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-238-1301
Mailing Address - Street 1:5704 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8713
Mailing Address - Country:US
Mailing Address - Phone:423-238-1301
Mailing Address - Fax:423-238-1302
Practice Address - Street 1:5704 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8713
Practice Address - Country:US
Practice Address - Phone:423-238-1301
Practice Address - Fax:423-238-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6211261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4022229OtherBLUE CROSS/BLUE SHIELD
TN3725829Medicare ID - Type Unspecified