Provider Demographics
NPI:1043237936
Name:FRANKLIN REHABILITATION AND SPORTS THERAPY INC
Entity Type:Organization
Organization Name:FRANKLIN REHABILITATION AND SPORTS THERAPY INC
Other - Org Name:SOUTHSIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHRACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:757-562-0990
Mailing Address - Street 1:1580 ARMORY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2452
Mailing Address - Country:US
Mailing Address - Phone:757-562-0990
Mailing Address - Fax:757-562-0496
Practice Address - Street 1:1580 ARMORY DR
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2452
Practice Address - Country:US
Practice Address - Phone:757-562-0990
Practice Address - Fax:757-562-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
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
VA4979699Medicaid
VA4979699Medicaid