Provider Demographics
NPI:1073701751
Name:SEQUATCHIE VALLEY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SEQUATCHIE VALLEY PHYSICAL THERAPY, LLC
Other - Org Name:OMNI REHAB, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MS
Authorized Official - Phone:423-949-7899
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-0373
Mailing Address - Country:US
Mailing Address - Phone:423-949-7899
Mailing Address - Fax:423-949-3416
Practice Address - Street 1:17919 RANKIN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7040
Practice Address - Country:US
Practice Address - Phone:423-949-7899
Practice Address - Fax:423-949-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty