Provider Demographics
NPI:1750413092
Name:PREMIER THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:PREMIER THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MPH
Authorized Official - Phone:423-623-7777
Mailing Address - Street 1:413 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2219
Mailing Address - Country:US
Mailing Address - Phone:423-623-7777
Mailing Address - Fax:423-623-0707
Practice Address - Street 1:413 W BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2219
Practice Address - Country:US
Practice Address - Phone:423-623-7777
Practice Address - Fax:423-623-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
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
TN3651863Medicare ID - Type UnspecifiedFACILITY PROVIDER #