NPIMap

Organization Active NPI

Independent Physical Therapy of Georgia, LLC

  • Physical Therapy Clinic/Center
  • Roswell, GA
National Provider Identifier
1184959645
Registry record updated Sep 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Practice address
1350 Upper Hembree Rd Ste 100
Roswell, GA 30076-0929
Phone
(770) 771-6751
Fax
(770) 754-9820
NPI assigned
Oct 16, 2009
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kevin Johanneson
Title
VP Revenue Cycle
Phone
(423) 238-7217

Other NPIs on the same Medicare enrollment 35

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

View all 35

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

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

National Provider Directory

National Provider Directory

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X Primary
Rehabilitation Clinic/Center 261QR0400X

Addresses

NPPES NPI Registry

Primary practice location

1350 Upper Hembree Rd Ste 100
Roswell, GA 30076-0929

Mailing address

6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217

Other names 1

NPPES NPI Registry
  • BenchMark Physical Therapy Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 20, 2017.

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505865600000",
    "number": "1184959645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564",
            "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": "1350 UPPER HEMBREE RD STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300760929",
            "telephone_number": "770-771-6751",
            "fax_number": "770-754-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-16",
        "last_updated": "2017-09-20",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "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": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BenchMark Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2017; 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.