NPIMap

Independent Physical Therapy of Ga, LLC

Organization Active NPI Physical Therapist · Lagrange, GA

NPI 1477078699 · NPPES record last updated Aug 9, 2017

Key facts

NPI
1477078699
Entity type
Organization (NPI type 2)
Primary specialty
Physical Therapist 225100000X
Legal business name
INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Practice address
112 Kia Dr Ste B
Lagrange, GA 30241-3731
Phone
(706) 668-6336
Fax
(706) 668-6033
NPI assigned
Aug 9, 2017
Organization subpart
No

Authorized official

Name
Kevin Johanneson
Title
VP Revenue Cycle
Phone
(423) 238-3220

Other NPIs on the same Medicare enrollment 35

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

View all 35

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

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

  • Bradley Smith, DPT Physical Therapist · Monroe, GA · NPI 1528783834
    NPD PHYSICAL THERAPIST
  • Carmen T Wurtz, P.T., D.P.T. Physical Therapist · Alpharetta, GA · NPI 1538568720
    NPD PHYSICAL THERAPIST
  • Jordyn Clay Glover, PT, DPT Physical Therapist · Arlington, VA · NPI 1871141382
    NPD PHYSICAL THERAPIST
  • Sheena Kattookaran, P.T. Physical Therapist · Arlington Heights, IL · NPI 1760561575
    NPD PHYSICAL THERAPIST

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

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

Tax ID family
Independent Physical TH (161 organizations share this tax ID)

Locations

5370 Highway 92
Ste 530
Fairburn, GA 30213
Phone (678) 666-4146

112 Kia Dr
#B
Lagrange, GA 30241
Phone (706) 668-6336

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225100000X Yes
Occupational Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225X00000X
Speech-Language Pathologist
Group: 193200000X MULTI-SPECIALTY GROUP		 235Z00000X

Addresses

Primary practice location

112 Kia Dr Ste B
Lagrange, GA 30241-3731

Mailing address

6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564

Other names

  • Benchmark PT - LaGrange Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 9, 2017.

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502236800000",
    "number": "1477078699",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 KIA DR STE B",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413731",
            "telephone_number": "706-668-6336",
            "fax_number": "706-668-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY OF GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-09",
        "last_updated": "2017-08-09",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "423-238-3220"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benchmark PT - LaGrange",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lagrange, GA

All providers in Lagrange, GA · Physical Therapist in Georgia

Sources for this page

Verify at the official NPI Registry.