Provider Demographics
NPI:1780366153
Name:TRUE VINE THERAPY SERVICES
Entity type:Organization
Organization Name:TRUE VINE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:STANTHONY
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:205-218-4723
Mailing Address - Street 1:724 COPPER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1675
Mailing Address - Country:US
Mailing Address - Phone:205-218-4723
Mailing Address - Fax:
Practice Address - Street 1:724 COPPER BRANCH RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1675
Practice Address - Country:US
Practice Address - Phone:205-218-4723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty