Provider Demographics
NPI:1114267986
Name:LIFT THERAPY, INC.
Entity Type:Organization
Organization Name:LIFT THERAPY, INC.
Other - Org Name:LIFT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-541-5000
Mailing Address - Street 1:101 JACKSON WALK PLAZA
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3008
Mailing Address - Country:US
Mailing Address - Phone:731-421-6950
Mailing Address - Fax:731-421-6999
Practice Address - Street 1:101 JACKSON WALK PLAZA
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3008
Practice Address - Country:US
Practice Address - Phone:731-421-6950
Practice Address - Fax:731-421-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446707Medicaid
TN446707Medicare Oscar/Certification