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NPI Code Detail

MEDICARE: INDEPENDENT PHYSICAL THERAPY OF GA, LLC

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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1386196681
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Provider Business Mailing Address
First Line : 8823 PRODUCTION LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-6511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6361 TALOKAS LN
Second Line : STE C170
City : COLUMBUS
State : GA
Zip : 31909-5642
Country : US
Telephone Number : 706-569-6250
Fax Number : 706-569-6335
Authorized Official
Title or Position : VP REVENUE CYCLE
Name : KEVIN JOHANNESON
Credential :
Telephone Number : 423-238-3220
Provider Enumeration Date : 11/03/2016
Last Update Date : 11/03/2016

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

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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