Healthcare Provider Details

I. General information

NPI: 1093819450
Provider Name (Legal Business Name): PROFESSIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date: 12/15/2006
Reactivation Date: 05/27/2008

III. Provider practice location address

3640 MUNDY MILL RD STE 102B
GAINESVILLE GA
30504-8226
US

IV. Provider business mailing address

8823 PRODUCTION LANE
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-8821
  • Fax: 770-287-8797
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TROY BAGE
Title or Position: PRESIDENT
Credential:
Phone: 423-238-7217