Provider Demographics
NPI:1053566463
Name:PRESTIGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PRESTIGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:931-722-2778
Mailing Address - Street 1:1159 TROTWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3038
Mailing Address - Country:US
Mailing Address - Phone:931-901-0318
Mailing Address - Fax:931-901-0319
Practice Address - Street 1:1159 TROTWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3038
Practice Address - Country:US
Practice Address - Phone:931-901-0318
Practice Address - Fax:931-901-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7920261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy