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General NPI Number Information
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NPI Number | 1225462740
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Entity Type | Organization
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Legal Business Name | INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 2120 W SPRING ST STE 1600
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City | MONROE
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State | GA
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Zip | 30655-3901
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Country | US
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Telephone | 678-712-3686
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Fax | 678-712-3689
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Provider Business Mailing Address
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Address Line | 6397 LEE HWY STE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4915
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Country | US
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Telephone | 423-238-7217
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Fax | 423-238-3473
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | KEVIN JOHANNESON
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Credential |
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Telephone | 423-238-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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