Provider Demographics
NPI:1013302777
Name:NULIFE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:NULIFE PHYSICAL THERAPY INC.
Other - Org Name:NULIFE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWMER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:615-325-9007
Mailing Address - Street 1:705 S. BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1628
Mailing Address - Country:US
Mailing Address - Phone:615-325-9007
Mailing Address - Fax:615-325-5794
Practice Address - Street 1:705 S. BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1628
Practice Address - Country:US
Practice Address - Phone:615-325-9007
Practice Address - Fax:615-325-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
TN1241261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)