Healthcare Provider Details

I. General information

NPI: 1619636495
Provider Name (Legal Business Name): PT SOLUTIONS OF MONTGOMERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W COLLEGE ST
COLUMBIANA AL
35051-9724
US

IV. Provider business mailing address

1100 CIRCLE 75 PKWY SE STE 1400
ATLANTA GA
30339-3067
US

V. Phone/Fax

Practice location:
  • Phone: 678-528-2076
  • Fax: 678-528-2064
Mailing address:
  • Phone: 678-459-3759
  • Fax: 678-567-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DALE MICHAEL YAKE
Title or Position: CEO
Credential:
Phone: 678-459-3758