Independent Physical Therapy of Georgia, LLC
Organization Active NPI Physical Therapy Clinic/Center · Dacula, GA
NPI 1184908071 · NPPES record last updated Oct 19, 2011
Key facts
- NPI
- 1184908071
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
- Practice address
- 3625 Braselton Hwy Ste 204
Dacula, GA 30019-4695 - Phone
- (423) 238-7217
- NPI assigned
- Oct 11, 2011
- Organization subpart
- No
Authorized official
- Name
- Troy D Bage
- Title
- President
- Phone
- (423) 238-7217
Other NPIs on the same Medicare enrollment 35
Practitioners 4
-
Daniel John Hallahan, PT, DPT, ATC
-
Traci Pope Jordan, PT, DPT
-
Michael Cody Malone, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Yes | ||
| Rehabilitation Clinic/Center | 261QR0400X |
Addresses
Primary practice location
3625 Braselton Hwy Ste 204
Dacula, GA 30019-4695
Mailing address
8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217
Other names
- BenchMark PT
Other providers in Dacula, GA
- Daniel Sukwoo Hwang
- Helen Ufuoma Ibim
- Hassanatu Idibia
- Imose Idubor
- Independent Physical Therapy of Ga, LLC
- Infinite Sky LLC
- Integrated Healthcare Center of Hamilton Mill LLC
- Integrative Medical Management Group
- Interventional Spine and Pain Management Center, PC
- Mustapha Timmy Issa
All providers in Dacula, GA · Physical Therapy Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2011. 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.