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
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1740837251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GA LLC

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5948 E LAKE PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4802
Country	:	US
Telephone Number	:	470-878-6059
Fax Number	:

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-2313

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	08/20/2019

Similar Medicare Providers

1376910455 — IOM PROFESSIONAL READERS, LLC
Practice Location Address:

5916 E LAKE PKWY , SUITE 194
MCDONOUGH, GA
30253-4802

Practice Phone: 214-295-6703
Practice Fax:

1689146755 — CHELSEA FENTON PT, DPT
Practice Location Address:

5948 E LAKE PKWY
MCDONOUGH, GA
30253-4802

Practice Phone: 470-878-6059
Practice Fax: 470-878-6217

1871135889 — FERNANDA LEACH
Practice Location Address:

5916 E LAKE PKWY STE 285
MCDONOUGH, GA
30253-4802

Practice Phone: 470-781-1209
Practice Fax: 470-200-3305

1992337125 — NAJRA MARIC PHARMD
Practice Location Address:

5900 E LAKE PKWY
MCDONOUGH, GA
30253-4802

Practice Phone: 770-954-4389
Practice Fax:

1518592641 — SHERYL GURLEY
Practice Location Address:

5900 E LAKE PKWY
MCDONOUGH, GA
30253-4802

Practice Phone: 770-954-4389
Practice Fax:

1669000162 — RAYNA STANDARD
Practice Location Address:

5900 E LAKE PKWY
MCDONOUGH, GA
30253-4802

Practice Phone: 770-954-4389
Practice Fax:

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.