Provider Demographics
NPI:1578644894
Name:CLINTON PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:CLINTON PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-457-1649
Mailing Address - Street 1:1921 N CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6747
Mailing Address - Country:US
Mailing Address - Phone:865-457-1649
Mailing Address - Fax:865-463-7825
Practice Address - Street 1:1921 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6747
Practice Address - Country:US
Practice Address - Phone:865-457-1649
Practice Address - Fax:865-463-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1501225100000X
TN5080225100000X
TN0556225100000X
TN7259225100000X
TN15492251E1200X
TN19142251X0800X
TN0156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651973Medicaid
TN3651973Medicare ID - Type Unspecified