Healthcare Provider Details

I. General information

NPI: 1154989218
Provider Name (Legal Business Name): PT SOLUTIONS OF ACWORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NORTHSIDE DR
VALDOSTA GA
31602-1861
US

IV. Provider business mailing address

1100 CIRCLE 75 PKWY SE STE 1400
ATLANTA GA
30339-3067
US

V. Phone/Fax

Practice location:
  • Phone: 229-262-3377
  • Fax: 229-262-3376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN PHILPOT
Title or Position: DIRECTOR REVENUE
Credential:
Phone: 678-403-3568