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General NPI Number Information
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NPI Number | 1922513415
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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 | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 863 W OGLETHORPE HWY STE 210
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City | HINESVILLE
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State | GA
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Zip | 31313-4491
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Country | US
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Telephone | 888-578-5231
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Fax | 888-629-0078
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Provider Business Mailing Address
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Address Line | 6397 LEE HWY STE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2564
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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 | VP REVENUE CYCLE
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Name | KEVIN JOHANNESON
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Credential |
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Telephone | 423-238-2313
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 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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