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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
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1447858105
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 : 423-238-7217
Fax Number :
Provider Business Practice Location Address
First Line : 5575 NEW NORTHSIDE DR STE 100
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30339-5334
Country : US
Telephone Number : 770-726-7867
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRYAN BARGANIER
Credential :
Telephone Number : 205-536-7602
Provider Enumeration Date : 10/15/2020
Last Update Date : 10/15/2020

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

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