Provider Demographics
NPI:1669406070
Name:PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF CHATTANOOGA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:REED
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:706-657-2700
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0942
Mailing Address - Country:US
Mailing Address - Phone:706-657-2700
Mailing Address - Fax:706-657-7965
Practice Address - Street 1:12415 N MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-0942
Practice Address - Country:US
Practice Address - Phone:706-657-2700
Practice Address - Fax:706-657-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5100496100OtherBLUECROSS BLUESHIELD GA
TN6109965001OtherCIGNA (COMMERICIAL)
TN=========OtherTAX IDENTIFICATION NUMBER
TN6109965001OtherCIGNA (COMMERICIAL)