Provider Demographics
NPI:1568442317
Name:COMPWHIZ INTERNATIONAL LLC DBA ST. LUKE'S THERAPY SERVICES
Entity Type:Organization
Organization Name:COMPWHIZ INTERNATIONAL LLC DBA ST. LUKE'S THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALILI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-626-3941
Mailing Address - Street 1:411 BLUE TOP RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3118
Mailing Address - Country:US
Mailing Address - Phone:423-626-3941
Mailing Address - Fax:
Practice Address - Street 1:411 BLUE TOP RD
Practice Address - Street 2:SUITE 5
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3118
Practice Address - Country:US
Practice Address - Phone:423-626-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3654705Medicare ID - Type UnspecifiedPHYSICAL THERAPY