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General NPI Number Information
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NPI Number | 1518364892
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Entity Type | Organization
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Legal Business Name | INDEPENDENT PHYSICAL THERAPY OF GA, LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1715 HOWELL MILL RD NW B2
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City | ATLANTA
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State | GA
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Zip | 30318-3167
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Country | US
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Telephone | 404-351-5432
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Fax | 404-352-1917
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Provider Business Mailing Address
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Address Line | 8823 PRODUCTION LN
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City | OOLTEWAH
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State | TN
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Zip | 37363-6511
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Country | US
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Telephone | 423-238-8923
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Fax | 423-954-7399
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Authorized Official
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Title or Position | VP REVENUE CYCLE MANAGER
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Name | KEVIN JOHANESSON
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Credential |
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Telephone | 423-238-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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