MEDICARE: INDEPENDENT PHYSICAL THERAPY OF GA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1124424205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GA, LLC

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	2500 DALLAS HWY SW STE 520
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2664
Country	:	US
Telephone Number	:	770-422-5078
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LISA BENETTO
Credential	:
Telephone Number	:	423-238-8923

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	12/08/2023

Similar Medicare Providers

1164506374 — TERI DANIELLE KIRKPATRICK PT
Practice Location Address:

2500 DALLAS HWY SW STE 520
MARIETTA, GA
30064-2664

Practice Phone: 678-383-1696
Practice Fax:

1881235414 — AGILITAS USA, INC.
Practice Location Address:

2500 DALLAS HWY SW STE 520
MARIETTA, GA
30064-2664

Practice Phone: 678-383-1696
Practice Fax: 678-681-9106

1598398901 — KATHERINE DIETZEL DPT
Practice Location Address:

2500 DALLAS HWY SW STE 520
MARIETTA, GA
30064-2664

Practice Phone: 678-383-1696
Practice Fax: 678-681-9106

1912862350 — FULFILLMENT CHIROPRACTIC, INC. D/B/A COOPERATIVE CHIROPRACTIC
Practice Location Address:

3901 MARY ELIZA TRCE NW STE 201
MARIETTA, GA
30064-1096

Practice Phone: 215-694-4831
Practice Fax:

1467566570 — DR. SCOT WILLIS MCCORMICK DC
Practice Location Address:

3901 MARY ELIZA TRCE NW STE 201
MARIETTA, GA
30064-1096

Practice Phone: 215-694-4831
Practice Fax:

1275044844 — POOLES PHARMACY INCORPORATED
Practice Location Address:

660 WHITLOCK AVE NW STE G
MARIETTA, GA
30064-3174

Practice Phone: 770-514-5115
Practice Fax: 770-428-1115

Directions to “INDEPENDENT PHYSICAL THERAPY OF GA, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.