Organization Name: | INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC |
NPI Number: | 1124389887 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KILEY RUSSELL (MANAGER) |
Mailing Address: | 3007 Panola Rd Ste C Lithonia |
State: | GA US |
Postal Code: | 300382492 |
Phone Number: | 7709871122 |
Fax Number: | 7709871149 |
NPI Enumeration Date: | 05/30/2012 |
NPI Last Update Date: | 06/05/2012 |
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: |