| Organization Name: | INDEPENDENT PHYSICAL THERAPY OF GA, LLC |
| NPI Number: | 1467556829 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN JOHANNESON (VP REVENUE CYCLE) |
| Mailing Address: | 590 441 Historic Hwy N Ste E Demorest |
| State: | GA US |
| Postal Code: | 305354561 |
| Phone Number: | 7067546611 |
| Fax Number: | 7067545834 |
| NPI Enumeration Date: | 09/07/2006 |
| NPI Last Update Date: | 08/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 12/15/2006 |
| NPI Reactivation Date: | 05/27/2008 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |