| Organization Name: | INDEPENDENT PHYSICAL THERAPY OF GA, LLC |
| NPI Number: | 1124295779 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN JOHANNESON (VP REVENUE CYCLE) |
| Mailing Address: | 5415 Thompson Mill Rd Hoschton |
| State: | GA US |
| Postal Code: | 305484132 |
| Phone Number: | 7709653508 |
| Fax Number: | 7709653279 |
| NPI Enumeration Date: | 05/13/2008 |
| NPI Last Update Date: | 08/31/2015 |
| 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: | |