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General NPI Number Information
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NPI Number | 1023023868
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Entity Type | Organization
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Legal Business Name | IN HOME REHAB GEORGIA LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/08/2007
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Provider Practice Location Address
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Address Line | 3053 INTREPID CLOSE
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City | MARIETTA
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State | GA
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Zip | 30062-6603
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Country | US
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Telephone | 770-973-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 3053 INTREPID CLOSE
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City | MARIETTA
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State | GA
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Zip | 30062-6603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIMMY BIGA
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Credential |
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Telephone | 770-973-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT003837
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1678
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License Number State | GA
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