NPIMap

Organization Active NPI

Independent Physical Therapy, LLC

Doing business as BenchMark of GA

  • Physical Therapy Clinic/Center
  • Douglasville, GA
National Provider Identifier
1124363304
Registry record updated Feb 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
INDEPENDENT PHYSICAL THERAPY, LLC
Doing business as
BenchMark of GA
Practice address
2750 Chapel Hill Rd Ste 1200
Douglasville, GA 30135-1721
Phone
(678) 981-6290
Fax
(678) 981-6291
NPI assigned
Nov 29, 2012
Last updated
Feb 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marvette Wallace
Title
Director of Contract Managment
Phone
(423) 238-7217

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

2750 Chapel Hill Rd Ste 1200
Douglasville, GA 30135-1721

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217

Other names 1

  • BenchMark of GA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000396 GA Part B Supplier - Clinic/Group Practice 2961312244 Receives reassigned benefits from 1,039 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

National Provider Directory

National Provider Directory
Tax ID family
Independent Phys Therapy161 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5415 Thompson Mill Rd
Hoschton, GA 30548
Phone (770) 965-3508

119 Canal St
Ste 104
Pooler, GA 31322
Phone (912) 330-8444

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1124363304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 CHAPEL HILL RD STE 1200",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351721",
            "telephone_number": "678-981-6290",
            "fax_number": "678-981-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MARVETTE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACT MANAGMENT",
        "authorized_official_telephone_number": "423-238-7217"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BenchMark of GA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.