Healthcare Provider Details

I. General information

NPI: 1134167851
Provider Name (Legal Business Name): NORTH GEORGIA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 APPALACHIAN HWY SUITE 2
BLUE RIDGE GA
30513-4295
US

IV. Provider business mailing address

5425 APPALACHIAN HWY SUITE 2
BLUE RIDGE GA
30513-4295
US

V. Phone/Fax

Practice location:
  • Phone: 706-632-8535
  • Fax: 706-632-8485
Mailing address:
  • Phone: 706-632-8535
  • Fax: 706-632-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DARNELL
Title or Position: OWNER
Credential: PT
Phone: 706-632-8535