Organization Name: | INDEPENDENT PHYSICAL THERAPY OF GA, LLC |
NPI Number: | 1174840409 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TROY D. BAGE (PRESIDENT) |
Mailing Address: | 3450 Cobb Pkwy Nw Ste 140 Acworth |
State: | GA US |
Postal Code: | 301018351 |
Phone Number: | 7709741978 |
Fax Number: | 7709741979 |
NPI Enumeration Date: | 04/27/2010 |
NPI Last Update Date: | 06/25/2010 |
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: |