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General NPI Number Information
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NPI Number | 1487260840
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Entity Type | Organization
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Legal Business Name | TOTEM PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 1806 RUSSELL PKWY STE 1400
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City | WARNER ROBINS
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State | GA
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Zip | 31088-5781
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Country | US
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Telephone | 478-235-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 121 PARTRIDGE TRL
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City | WARNER ROBINS
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State | GA
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Zip | 31088-6592
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL F JACKSON JR.
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Credential | DPT
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Telephone | 478-235-4441
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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 |
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License Number State |
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