Provider Demographics
NPI: | 1922649151 |
---|---|
Name: | CHEST PT 101, LLC |
Entity Type: | Organization |
Organization Name: | CHEST PT 101, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DON |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TAMIKA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | GRUBBS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 407-730-0795 |
Mailing Address - Street 1: | 4745 OLD HIGHWAY 37 STE 103 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKELAND |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33813-2031 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 833-327-8101 |
Mailing Address - Fax: | 833-327-8101 |
Practice Address - Street 1: | 4745 OLD HIGHWAY 37 STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | LAKELAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33813-2031 |
Practice Address - Country: | US |
Practice Address - Phone: | 833-327-8101 |
Practice Address - Fax: | 833-327-8101 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-09-29 |
Last Update Date: | 2020-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2279E1000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Educational | Group - Multi-Specialty |
No | 2279P1005X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Pulmonary Rehabilitation | Group - Multi-Specialty |
No | 2279P1006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Pulmonary Function Technologist | Group - Multi-Specialty |
No | 251E00000X | Agencies | Home Health | Group - Multi-Specialty |