Provider Demographics
NPI:1639166127
Name:BARTLETT THERAPY CENTER
Entity Type:Organization
Organization Name:BARTLETT THERAPY CENTER
Other - Org Name:MEMPHIS THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-309-1501
Mailing Address - Street 1:5142 STAGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3164
Mailing Address - Country:US
Mailing Address - Phone:901-309-1501
Mailing Address - Fax:901-309-0454
Practice Address - Street 1:5142 STAGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3164
Practice Address - Country:US
Practice Address - Phone:901-309-1501
Practice Address - Fax:901-309-0454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMPHIS THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN444534Medicare Oscar/Certification