Healthcare Provider Details

I. General information

NPI: 1366996746
Provider Name (Legal Business Name): PT SOLUTIONS OF ACWORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CUMMING HWY SUITE 1360
CANTON GA
30115-2986
US

IV. Provider business mailing address

PO BOX 441146
KENNESAW GA
30160-9522
US

V. Phone/Fax

Practice location:
  • Phone: 844-734-2204
  • Fax: 770-423-3369
Mailing address:
  • Phone: 770-917-1395
  • Fax: 770-423-3369

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: JENNIFER L. HALL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 770-615-4856