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General NPI Number Information
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NPI Number | 1053338715
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Entity Type | Organization
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Legal Business Name | NORTH VALDOSTA THERAPY SERVICES INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 4611 TILLMAN BLUFF RD
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City | VALDOSTA
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State | GA
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Zip | 31602-4965
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Country | US
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Telephone | 229-219-0700
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Fax | 229-219-0702
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Provider Business Mailing Address
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Address Line | 4611 TILLMAN BLUFF RD
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City | VALDOSTA
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State | GA
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Zip | 31602-4965
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Country | US
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Telephone | 229-245-1048
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Fax | 229-219-0702
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. ROBERT HALMAN BENNETT
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Credential | MPT
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Telephone | 229-219-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT007616
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License Number State | GA
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