Brian Eugene Vandiver, PT
Individual provider Active NPI Physical Therapist · Commerce, GA
NPI 1194805689 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194805689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 004868 (GA)
- Practice address
- 40095 US Highway 441
Elite Physical Therapy
Commerce, GA 30529 - Phone
- (706) 335-3816
- Fax
- (706) 335-3819
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Physical Therapy, Inc. | Physical Therapist | Past |
Accepting new patients |
| Peak Rehabilitation, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 004868 | GA | Yes |
Addresses
Primary practice location
40095 US Highway 441
Elite Physical Therapy
Commerce, GA 30529
Mailing address
2129 Unity Church Circle
Maysville, GA 30558
Phone (706) 652-3907
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00981439A | Medicaid | GA |
Other providers in Commerce, GA
- Laurie Truitt
- Joshua W. Upton
- Urgent Care Banks Crossing LLC
- Urgent Care Banks Crossing LLC
- US Medical Corporation LLC
- Amy Vaughan
- Paloma Vega
- Carol Vile
- Cherica Voyles
- Yatrik Vyas
All providers in Commerce, 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 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.