Provider Demographics
NPI:1275641490
Name:LEADER PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:LEADER PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:MEMPHIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:5039 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5701
Mailing Address - Country:US
Mailing Address - Phone:901-818-9746
Mailing Address - Fax:901-818-9741
Practice Address - Street 1:6600 STAGE ROAD
Practice Address - Street 2:SUITE 129
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2866
Practice Address - Country:US
Practice Address - Phone:901-371-0732
Practice Address - Fax:901-371-0859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEADER PHYSICAL THERAPY LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4823250002Medicare NSC
TN446628Medicare Oscar/Certification