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General NPI Number Information
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NPI Number | 1588336754
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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 | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 7951 VILLA RICA HWY STE 117
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City | DALLAS
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State | GA
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Zip | 30157-8667
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Country | US
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Telephone | 470-977-3310
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Fax | 470-819-2997
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | BRYAN BARGANIER
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Credential |
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Telephone | 205-536-7602
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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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