Healthcare Provider Details

I. General information

NPI: 1184817462
Provider Name (Legal Business Name): TRINITY THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E JARMAN ST STE B
HAZLEHURST GA
31539-6133
US

IV. Provider business mailing address

PO BOX 1005
HAZLEHURST GA
31539-1005
US

V. Phone/Fax

Practice location:
  • Phone: 912-375-2009
  • Fax: 912-379-0081
Mailing address:
  • Phone: 912-375-2009
  • Fax: 912-379-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. ANDREW C LAWRENCE
Title or Position: OWNER
Credential:
Phone: 912-375-2009