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General NPI Number Information
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NPI Number | 1063912178
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Entity Type | Organization
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Legal Business Name | PINNACLE PHYSICAL THERAPY & SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 789 HIGHWAY 96 STE 2B
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City | BONAIRE
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State | GA
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Zip | 31005-3357
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Country | US
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Telephone | 478-302-5111
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Fax | 478-225-6453
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Provider Business Mailing Address
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Address Line | 789 HIGHWAY 96 STE 2B
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City | BONAIRE
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State | GA
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Zip | 31005-3357
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Country | US
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Telephone | 478-302-5111
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Fax | 478-225-6453
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | WILLIAM SHANE VALIGORA
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Credential | DPT
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Telephone | 478-919-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT010208
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License Number State | GA
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