Provider Demographics
NPI:1841977956
Name:FELLOWSHIP PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FELLOWSHIP PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-788-4636
Mailing Address - Street 1:2120 S ROAN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7675
Mailing Address - Country:US
Mailing Address - Phone:423-788-4636
Mailing Address - Fax:423-558-0011
Practice Address - Street 1:2120 S ROAN ST STE 105
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7675
Practice Address - Country:US
Practice Address - Phone:423-788-4636
Practice Address - Fax:423-558-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty