MEDICARE: INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QX0100X	Occupational Medicine Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QR0400X	Rehabilitation Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1770837445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GEORGIA, 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	:	3885 PRINCETON LAKES WAY SW STE 408
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5599
Country	:	US
Telephone Number	:	404-344-2823
Fax Number	:	404-629-3737

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-7217

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	11/06/2018

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