NPIMap

Organization Active NPI

Independent Physical Therapy of Ga, LLC

  • Physical Therapist
  • Statesboro, GA
National Provider Identifier
1508424250
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Practice address
840 Buckhead Dr Ste C
Statesboro, GA 30458-2752
Phone
(912) 259-9355
NPI assigned
May 29, 2019
Last updated
May 29, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Authorized official

Name
Kevin Johanneson
Title
VP Revenue Cycle
Phone
(423) 238-2313

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

840 Buckhead Dr Ste C
Statesboro, GA 30458-2752

Mailing address

6397 Lee Hwy Ste 300
Chattanooga, TN 37421-4915

National Provider Directory

National Provider Directory
Tax ID family
Independent Phys Ther161 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

840 Buckhead Dr
Ste C
Statesboro, GA 30458
Phone (912) 259-9355

NPI Registry JSON

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1508424250",
    "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": "374214915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 BUCKHEAD DR STE C",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304582752",
            "telephone_number": "912-259-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY OF GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "423-238-2313"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.