Provider Demographics
NPI:1760558480
Name:LONGS PHYSICAL THERAPY CLINIC
Entity Type:Organization
Organization Name:LONGS PHYSICAL THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHYSICAL
Authorized Official - Phone:931-424-9300
Mailing Address - Street 1:1672 WEST COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38477
Mailing Address - Country:US
Mailing Address - Phone:931-424-9300
Mailing Address - Fax:931-424-0833
Practice Address - Street 1:1672 WEST COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38477
Practice Address - Country:US
Practice Address - Phone:931-424-9300
Practice Address - Fax:931-424-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy