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
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1952900912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY OF GA LLC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 POPLAR SPRINGS RD
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2808
Country	:	US
Telephone Number	:	706-937-3735
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN BARGANIER
Credential	:
Telephone Number	:	205-536-7602

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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