Organization Name: | INDEPENDENT PHYSICAL THERAPY, LLC |
NPI Number: | 1013257856 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARVETTE WALLACE (DIRECTOR CONTRACT MANAGEMENT) |
Mailing Address: | 5370 Campbellton Fairburn Rd Ste 530 Fairburn |
State: | GA US |
Postal Code: | 302132296 |
Phone Number: | 6786664146 |
Fax Number: | 6786664148 |
NPI Enumeration Date: | 02/14/2013 |
NPI Last Update Date: | 02/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |