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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
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1790293231
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 : 37421-2564
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4446 WASHINGTON RD STE 8
Second Line :
City : EVANS
State : GA
Zip : 30809-6361
Country : US
Telephone Number : 706-869-3352
Fax Number : 706-869-3299
Authorized Official
Title or Position : VP REVENUE CYCLE
Name : KEVIN JOHANNESON
Credential :
Telephone Number : 423-238-3220
Provider Enumeration Date : 01/18/2018
Last Update Date : 01/18/2018

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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.

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