Provider Demographics
NPI:1508869462
Name:RISINGER, ADAM BROOKS (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:BROOKS
Last Name:RISINGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-9461
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:3964 GOODMAN RD E
Practice Address - Street 2:SUITE 111
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8761
Practice Address - Country:US
Practice Address - Phone:662-890-6953
Practice Address - Fax:662-890-6954
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT5427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS620819926OtherBCBS
TN620819926OtherAETNA
TNP00266256OtherRAILROAD MEDICARE
TN4041683OtherBCBS
TN0723280001OtherPALMETTO
TNP00266256OtherRAILROAD MEDICARE