Provider Demographics
NPI:1457498404
Name:PINNACLE PHYSICAL MEDICINE & REHAB
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL MEDICINE & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-855-5053
Mailing Address - Street 1:2605 JENKINS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1177
Mailing Address - Country:US
Mailing Address - Phone:422-385-5505
Mailing Address - Fax:423-855-5856
Practice Address - Street 1:2605 JENKINS RD
Practice Address - Street 2:STE 2
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1177
Practice Address - Country:US
Practice Address - Phone:422-385-5505
Practice Address - Fax:423-855-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723232Medicare ID - Type Unspecified