Provider Demographics
NPI:1326048737
Name:PHYSICAL MEDICINE CENTER OF THE CUMBERLANDS
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE CENTER OF THE CUMBERLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CERT MDT, CSCS
Authorized Official - Phone:931-823-1200
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-0494
Mailing Address - Country:US
Mailing Address - Phone:931-823-1200
Mailing Address - Fax:931-823-1209
Practice Address - Street 1:7385 BRADFORD HICKS DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-2239
Practice Address - Country:US
Practice Address - Phone:931-823-1200
Practice Address - Fax:931-823-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051351OtherBLUE CROSS BLUE SHIELD TN
TN3051351OtherBLUE CROSS BLUE SHIELD TN