Healthcare Provider Details

I. General information

NPI: 1366364119
Provider Name (Legal Business Name): 416 PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STATE ST
COMMERCE GA
30529-1920
US

IV. Provider business mailing address

67 LIBERTY FREEDOM LN
MAYSVILLE GA
30558-9812
US

V. Phone/Fax

Practice location:
  • Phone: 706-968-0479
  • Fax:
Mailing address:
  • Phone: 706-968-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AUSTIN PEARSON
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: DPT
Phone: 706-968-0479