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	:	1154281848
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 ATLANTA HWY STE 13
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3264
Country	:	US
Telephone Number	:	470-994-9659
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	LAUREN HILL
Credential	:
Telephone Number	:	423-238-7217

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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