MEDICARE: PT SOLUTIONS OF MONTGOMERY, 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	:	1720678667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT SOLUTIONS OF MONTGOMERY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 441146
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30160-9522
Country	:	US
Telephone Number	:	678-459-3758
Fax Number	:	678-567-6737

Provider Business Practice Location Address
First Line	:	7850 VAUGHN RD STE 100
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1333
Country	:	US
Telephone Number	:	334-396-2710
Fax Number	:	334-396-2115

Authorized Official
Title or Position	:	CEO
Name	:	MR. DALE YAKE
Credential	:
Telephone Number	:	334-396-2110

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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