Independent Physical Therapy of Georgia, LLC
Organization Active NPI Physical Therapy Clinic/Center · Atlanta, GA
NPI 1770837445 · NPPES record last updated Nov 6, 2018
Key facts
- NPI
- 1770837445
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
- Practice address
- 3885 Princeton Lakes Way SW Ste 408
Atlanta, GA 30331-5599 - Phone
- (404) 344-2823
- Fax
- (404) 629-3737
- NPI assigned
- Nov 2, 2012
- Organization subpart
- No
Authorized official
- Name
- Kevin Johanneson
- Title
- VP Revenue Cycle
- Phone
- (423) 238-7217
Other NPIs on the same Medicare enrollment 35
Practitioners 15
-
Pamela Jean Frey, PT
-
Steven Thomas Hightshue, PT, DPT
-
Eliana Lanphar, PT
-
Calvin Ryan McMillan, DPT
-
Laura Christine Schirmer, PT, DPT
-
Gina Misitano Thurman, OTR/L
-
Kirsten Tyler Lisk, DPT
-
Clennysha Jones, PT, DPT
-
Raymond Eralino Padilla, PT, DPT
-
Amber Steele, PT, DPT
-
Maurice Antonio Whalen, PT, DPT
-
Madison Larson, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
3885 Princeton Lakes Way SW
Ste 408
Atlanta, GA 30331
Phone (404) 344-2823
4959 Bill Gardner Pkwy
Ste 109
Locust Grove, GA 30248
Phone (770) 914-9285
4404 Hugh Howell Rd
Ste 18
Tucker, GA 30084
Phone (770) 493-5543
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Yes | ||
| Rehabilitation Clinic/Center | 261QR0400X | |||
| Occupational Medicine Clinic/Center | 261QX0100X |
Addresses
Primary practice location
3885 Princeton Lakes Way SW Ste 408
Atlanta, GA 30331-5599
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217
Other practice location 1
3645 Marketplace Blvd Ste 160
East Point, GA 30344-5749
Phone (404) 662-2195
Other names
- BenchMark
Other providers in Atlanta, GA
- Independent Physical Therapy of Georgia, LLC
- Independent Physical Therapy of Georgia, LLC
- Independent Physical Therapy of Georgia, LLC
- Independent Physical Therapy of Georgia, LLC
- Independent Physical Therapy of Georgia, LLC
- Independent Physical Therapy of Georgia, LLC
- Independent Wellness Group
- Sri Nitya Reddy Reddy Induri
- Infant Connections, LLC
- Lisette Infante
All providers in Atlanta, GA · Physical Therapy Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.