Provider Demographics
NPI:1326465923
Name:WESTERN TENNESSEE PHYSICAL THERAPY AND REHAB
Entity Type:Organization
Organization Name:WESTERN TENNESSEE PHYSICAL THERAPY AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JALPA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-494-4991
Mailing Address - Street 1:2233 STOKES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1818
Mailing Address - Country:US
Mailing Address - Phone:931-648-2224
Mailing Address - Fax:931-648-2225
Practice Address - Street 1:2233 STOKES RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1818
Practice Address - Country:US
Practice Address - Phone:931-648-2224
Practice Address - Fax:931-648-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty