South Georgia Therapy Services, P.C.
Organization Active NPI Physical Therapist · Glennville, GA
NPI 1104080266 · NPPES record last updated Jul 29, 2008
Key facts
- NPI
- 1104080266
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT003337 (GA)
- Legal business name
- SOUTH GEORGIA THERAPY SERVICES, P.C.
- Practice address
- 104 W Rustin St
Glennville, GA 30427-1805 - Phone
- (912) 654-2385
- Fax
- (912) 654-2394
- NPI assigned
- Jul 17, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Kenneth Lane Durrence, P.T.
- Title
- Owner/P.T.
- Phone
- (912) 654-2385
Practitioners 2
-
Victoria Kangeter Griffith, D.P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080813000155 | GA | Part B Supplier - Clinic/Group Practice | 9032284914 |
Receives reassigned benefits from 2 practitioners Practice locations: Glennville, GA |
National Provider Directory
Locations
104 W Rustin St
Glennville, GA 30427
Phone (912) 654-2385
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT003337 | GA | Yes |
Addresses
Primary practice location
104 W Rustin St
Glennville, GA 30427-1805
Mailing address
104 W Rustin St
Glennville, GA 30427-1805
Phone (912) 654-2385
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161037534A | Medicaid | GA |
Other names
- Kenneth L. Durrence, P.T.
Other providers in Glennville, GA
- Francesca Alicia Rao
- Michelle Ray
- Daniel Scott Rogers
- Shujiao Gui
- Austin Brett Snyder
- Southern Comfort Adult Day Service LLC
- Southern Medical Associates, LLC
- Patrice Stephens
- Stepping Stones Family Wellness Center, LLC
- Strickland'S Pharmacy, Inc.
All providers in Glennville, GA · Physical Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.