Provider Demographics
NPI:1497494066
Name:SCENIC CITY PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:SCENIC CITY PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-455-8358
Mailing Address - Street 1:5819 WINDING LN STE 101
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4067
Mailing Address - Country:US
Mailing Address - Phone:615-512-8448
Mailing Address - Fax:800-470-1905
Practice Address - Street 1:5819 WINDING LN STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4067
Practice Address - Country:US
Practice Address - Phone:615-512-8448
Practice Address - Fax:800-470-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty