Provider Demographics
NPI:1174707012
Name:TOTAL CARE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:TOTAL CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:OMOTUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:901-761-9798
Mailing Address - Street 1:5575 POPLAR AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3856
Mailing Address - Country:US
Mailing Address - Phone:901-761-9798
Mailing Address - Fax:901-761-9799
Practice Address - Street 1:5575 POPLAR AVENUE
Practice Address - Street 2:SUITE 321
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-761-9798
Practice Address - Fax:901-761-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003392261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy