Provider Demographics
NPI:1750441325
Name:INNOVATIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOOLFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-515-0110
Mailing Address - Street 1:620 TRACE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1584
Mailing Address - Country:US
Mailing Address - Phone:501-515-0110
Mailing Address - Fax:870-482-1515
Practice Address - Street 1:620 TRACE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1584
Practice Address - Country:US
Practice Address - Phone:501-515-0110
Practice Address - Fax:870-482-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006287261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728330Medicare PIN