MEDICARE: ADVANCED RECOVERY THERAPY 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	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1134012453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED RECOVERY THERAPY LLC

Provider Business Mailing Address
First Line	:	3829 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6236
Country	:	US
Telephone Number	:	770-321-0696
Fax Number	:	405-603-1465

Provider Business Practice Location Address
First Line	:	3829 ROSWELL RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6236
Country	:	US
Telephone Number	:	770-321-0696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH KASKIE
Credential	:
Telephone Number	:	770-789-2225

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	05/11/2026

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