MEDICARE: INDEPENDENT PHYSICAL THERAPY OF GA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073198651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GA, LLC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 OGEECHEE RD # 440
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-9515
Country	:	US
Telephone Number	:	912-777-3378
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN BARGANIER
Credential	:
Telephone Number	:	205-536-7602

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/23/2021

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