Provider Demographics
NPI:1841074101
Name:PATRIOT PHYSICAL THERAPY
Entity type:Organization
Organization Name:PATRIOT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAVILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-699-0688
Mailing Address - Street 1:7003 SHALLOWFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6722
Mailing Address - Country:US
Mailing Address - Phone:423-888-6238
Mailing Address - Fax:423-220-8238
Practice Address - Street 1:7003 SHALLOWFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6722
Practice Address - Country:US
Practice Address - Phone:423-888-6238
Practice Address - Fax:423-220-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty