MEDICARE: PT SOLUTIONS OF ACWORTH, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972659332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT SOLUTIONS OF ACWORTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 242278
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-2278
Country	:	US
Telephone Number	:	334-625-5795
Fax Number	:	334-396-4905

Provider Business Practice Location Address
First Line	:	1816 EAGLE DR
Second Line	:	BUILDING 100, SUITE C
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-8272
Country	:	US
Telephone Number	:	770-516-9191
Fax Number	:	678-802-7377

Authorized Official
Title or Position	:	CEO
Name	:	MR. DALE YAKE
Credential	:	DPT
Telephone Number	:	678-403-3560

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	02/09/2016

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