Independent Physical Therapy
NPI 1104464908ActiveOrganization· Physical Therapist· Chattanooga, TN
Physical Therapist in Chattanooga, Tennessee, registered in NPPES in December 2019. The authorized official on file is Kevin Johanneson, Vp Revenue Cycle.
Overview
| NPI | 1104464908 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 12, 2019 |
| Last updated in NPPES | Dec 12, 2019 |
| Certified by provider | Dec 12, 2019 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Occupational Therapist | 225X00000X | — | — |
| Speech-Language Pathologist | 235Z00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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