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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 : 1861878217
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Provider Business Mailing Address
First Line : 8823 PRODUCTION LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-6511
Country : US
Telephone Number : 423-238-8923
Fax Number :
Provider Business Practice Location Address
First Line : 2065 GRAYSON HWY STE B
Second Line :
City : GRAYSON
State : GA
Zip : 30017-1766
Country : US
Telephone Number : 678-376-0213
Fax Number : 678-376-0215
Authorized Official
Title or Position : VP REVENUE CYCLE
Name : KEVIN JOHANNESON
Credential :
Telephone Number : 423-238-8923
Provider Enumeration Date : 08/08/2015
Last Update Date : 08/08/2015

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Directions to “INDEPENDENT PHYSICAL THERAPY OF GA, LLC ” Practice Location

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