MEDICARE: PT SOLUTIONS OF ACWORTH, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1770035263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT SOLUTIONS OF ACWORTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 441146
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30160-9522
Country	:	US
Telephone Number	:	770-917-1935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4880 LOWER ROSWELL RD
Second Line	:	SUITE 625
City	:	MARIETTA
State	:	GA
Zip	:	30068-4375
Country	:	US
Telephone Number	:	844-734-2204
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JENNIFER HALL
Credential	:
Telephone Number	:	770-615-4856

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	10/31/2016

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