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
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1629746821
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	:	6586 GA HIGHWAY 40 E STE B3
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-4041
Country	:	US
Telephone Number	:	912-809-3015
Fax Number	:	912-525-2692

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN BARGANIER
Credential	:
Telephone Number	:	205-536-7602

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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