MEDICARE: HILLSTRAND PHYSICAL 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336895150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSTRAND PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3685 BRASELTON HWY STE 108
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-5920
Country	:	US
Telephone Number	:	470-214-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	3685 BRASELTON HWY STE 108
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-5920
Country	:	US
Telephone Number	:	470-214-3288
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL HILLSTRAND
Credential	:	DPT
Telephone Number	:	470-214-3288

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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