Provider Demographics
NPI:1831308147
Name:ERWIN PHYSICAL THERAPY
Entity type:Organization
Organization Name:ERWIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-854-0001
Mailing Address - Street 1:PO BOX 5748
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5748
Mailing Address - Country:US
Mailing Address - Phone:423-854-0001
Mailing Address - Fax:423-854-0002
Practice Address - Street 1:1201 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-9168
Practice Address - Country:US
Practice Address - Phone:423-854-0001
Practice Address - Fax:423-854-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003577173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3645345Medicaid
TN3645345Medicaid
TN3645345Medicare ID - Type Unspecified