Provider Demographics
NPI:1659508604
Name:CHATTANOOGA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHATTANOOGA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NED
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MTC
Authorized Official - Phone:423-648-4490
Mailing Address - Street 1:1201 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2714
Mailing Address - Country:US
Mailing Address - Phone:423-648-4490
Mailing Address - Fax:423-648-4491
Practice Address - Street 1:1201 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2714
Practice Address - Country:US
Practice Address - Phone:423-648-4490
Practice Address - Fax:423-648-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6542261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509785Medicaid
TN1509785Medicaid