Impact Physical Therapy, LLC
NPI 1174709430ActiveOrganization· Physical Therapist· Lebanon, TN
Physical Therapist in Lebanon, Tennessee, registered in NPPES in January 2008. The authorized official on file is John Boucher, P.T., Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1174709430 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 17, 2008 |
| Last updated in NPPES | May 12, 2023 |
| Certified by provider | May 12, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TN) |
|---|
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