Provider Demographics
NPI:1407912017
Name:PHYSIO ART AND REHAB CLINIC, INC.
Entity Type:Organization
Organization Name:PHYSIO ART AND REHAB CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAFAA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:615-896-8500
Mailing Address - Street 1:433 E BURTON ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3855
Mailing Address - Country:US
Mailing Address - Phone:615-896-8500
Mailing Address - Fax:615-895-9551
Practice Address - Street 1:433 E BURTON ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3855
Practice Address - Country:US
Practice Address - Phone:615-896-8500
Practice Address - Fax:615-895-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2200485OtherBCBS
TN5827004OtherAETNA
TN0446539Medicaid
TN6440023OtherUHC
TN0446539Medicaid