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General NPI Number Information
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NPI Number | 1477826121
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Entity Type | Organization
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Legal Business Name | INTEGRATED PHYSICAL THERAPY & PERSONAL TRAINING, LLC
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 251 RIVERBEND TRL
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6042
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Country | US
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Telephone | 678-717-9113
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Fax | 770-942-3053
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Provider Business Mailing Address
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Address Line | 251 RIVERBEND TRL
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6042
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Country | US
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Telephone | 678-717-9113
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Fax | 770-942-3053
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RENEE L DUNN
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Credential | P.T.
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Telephone | 678-717-9113
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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 | PT006856
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License Number State | GA
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