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
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1215599501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GA LLC

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 BRADLEY PARK DR STE C-2
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3620
Country	:	US
Telephone Number	:	414-222-4422
Fax Number	:

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-2313

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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Directions to “INDEPENDENT PHYSICAL THERAPY OF GA LLC ” Practice Location

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