# INTENSIVE THERAPY CENTER OF GEORGIA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134459175
- **Authorized official:** AMIE LOCICERO PT (PRESIDENT)
- **Authorized official phone:** (678) 377-2833

## Contact information

- **Practice address:** 545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
- **Practice address phone:** (678) 377-2833
- **Practice address fax:** (678) 377-2882
- **Mailing address:** 545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
- **Mailing address phone:** (678) 377-2833
- **Mailing address fax:** (678) 377-2882

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | — | NULL | Yes |
| 2251P0200X | Pediatric Physical Therapist | — | — | Yes |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 01/13/2010
- **Last updated:** 01/13/2010