MEDICARE: ASCENSION PHYSICAL THERAPY AND PERFORMANCE INSTITUTE OF GEORGIA 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1225990963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION PHYSICAL THERAPY AND PERFORMANCE INSTITUTE OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 251
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-0251
Country	:	US
Telephone Number	:	706-604-4868
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	706-604-4868
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. QUINTON TYLER BUCKNER
Credential	:	DPT
Telephone Number	:	706-604-4868

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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