Organization
INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Active
Other names
Benchmark PT - Shallowford
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANESON (VP REVENUE CYCLE)
(423) 238-3220
Entity
Organization
Contact information
Practice address
3855 SHALLOWFORD RD, 415, MARIETTA, GA 30062-4195
(678) 352-0828
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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