Provider Demographics
NPI:1114905643
Name:BENTON COUNTY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BENTON COUNTY PHYSICAL THERAPY
Other - Org Name:DOVER REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PINION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-232-0057
Mailing Address - Street 1:P.O. BOX 465
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242
Mailing Address - Country:US
Mailing Address - Phone:931-232-0057
Mailing Address - Fax:931-232-0067
Practice Address - Street 1:543 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-5966
Practice Address - Country:US
Practice Address - Phone:931-232-0057
Practice Address - Fax:931-232-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002294225100000X
TNPT2294261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3106297OtherBLUE CROSS BLUE SHIELD
TN044-6602Medicaid
TN0446602Medicaid
TN446602Medicare Oscar/Certification
TN44-6602Medicare PIN