Healthcare Provider Details

I. General information

NPI: 1023023868
Provider Name (Legal Business Name): IN HOME REHAB GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 INTREPID CLOSE
MARIETTA GA
30062-6603
US

IV. Provider business mailing address

3053 INTREPID CLOSE
MARIETTA GA
30062-6603
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-2207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1678
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT003837
License Number StateGA

VIII. Authorized Official

Name: JIMMY BIGA
Title or Position: OWNER
Credential:
Phone: 770-973-2207