Provider Demographics
NPI:1609007608
Name:WESTERN TENNESSEE PHYSICAL THERAPY & REHAB
Entity Type:Organization
Organization Name:WESTERN TENNESSEE PHYSICAL THERAPY & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HERAT
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:248-259-5980
Mailing Address - Street 1:211 A DUNBAR CAVE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:248-259-5980
Mailing Address - Fax:931-648-2225
Practice Address - Street 1:211 A DUNBAR CAVE ROAD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:248-259-5980
Practice Address - Fax:931-648-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty