Healthcare Provider Details

I. General information

NPI: 1467556829
Provider Name (Legal Business Name): INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date: 12/15/2006
Reactivation Date: 05/27/2008

III. Provider practice location address

590 441 HISTORIC HWY N STE E
DEMOREST GA
30535-4561
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-6611
  • Fax: 706-754-5834
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN HILL
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 423-558-0493