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General NPI Number Information
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NPI Number | 1346683588
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Entity Type | Organization
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Legal Business Name | INTOWN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 495 MORELAND AVE SE STE B
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City | ATLANTA
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State | GA
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Zip | 30316-1552
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Country | US
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Telephone | 404-883-2204
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Fax | 404-393-3270
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Provider Business Mailing Address
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Address Line | 495 MORELAND AVE SE STE B
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City | ATLANTA
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State | GA
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Zip | 30316-1552
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Country | US
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Telephone | 404-883-2204
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Fax | 404-393-3270
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Authorized Official
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Title or Position | OWNER
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Name | DR. INGRID A ANDERSON
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Credential | PT, DPT
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Telephone | 404-883-2304
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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 | PT010150
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License Number State | GA
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