| Organization Name: | PEACH STATE PROVIDERS GROUP INC |
| NPI Number: | 1629111802 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENDA R TALLEY (PHYSICAL THERAPIST) |
| Mailing Address: | 7146 Southlake Parkway Morrow |
| State: | GA US |
| Postal Code: | 30260 |
| Phone Number: | 7709609979 |
| Fax Number: | 7709609662 |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1741 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |