Organization Active NPI

Innovation Therapy and Wellness, LLC

  • Physical Therapist
  • Vidalia, GA
National Provider Identifier
1750921284
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
INNOVATION THERAPY AND WELLNESS, LLC
Practice address
401 E 1St St Ste B
Vidalia, GA 30474-4624
Phone
(912) 403-3300
NPI assigned
Jan 13, 2020
Last updated
Jan 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
INNOVATION THERAPY AND WELLNESS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Authorized official

Name
Glen Posey
Title
Owner
Phone
(912) 403-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

401 E 1St St Ste B
Vidalia, GA 30474-4624

Mailing address

118 Azalea Rd Ste 11
Baxley, GA 31513-9197

National Provider Directory

National Provider Directory
Part of
Innovation Therapy

Locations

118 Azalea Rd
Ste 11
Baxley, GA 31513
Phone (912) 245-2855

3301 E 1st St
#B
Vidalia, GA 30474
Phone (912) 537-0888

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1750921284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 AZALEA RD STE 11",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315139197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 1ST ST STE B",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304744624",
            "telephone_number": "912-403-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATION THERAPY AND WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNOVATION THERAPY AND WELLNESS, LLC",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "POSEY",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-403-3300"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.