Healthcare Provider Details

I. General information

NPI: 1124344114
Provider Name (Legal Business Name): TOCCOA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 FALLS RD
TOCCOA GA
30577-2411
US

IV. Provider business mailing address

1656 FALLS RD
TOCCOA GA
30577-2411
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-5344
  • Fax: 770-622-5388
Mailing address:
  • Phone: 706-886-4680
  • Fax: 706-886-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT000558
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberPT000558
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT000558
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAY H WILLIAMS
Title or Position: CEO
Credential: PT
Phone: 706-886-4680