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General NPI Number Information
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NPI Number | 1780947978
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Entity Type | Organization
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Legal Business Name | INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 2255 PEACHTREE RD NE STE G
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City | ATLANTA
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State | GA
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Zip | 30309-1101
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Country | US
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Telephone | 404-351-3257
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Fax | 404-351-3896
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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 | 423-238-7217
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Fax | 423-238-3473
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Authorized Official
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Title or Position | MANAGER
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Name | KILEY RUSSELL
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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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 | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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