Organization
INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Active
Other names
BenchMark PT - Pooler
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP OF REVENUE)
(423) 238-3220
Entity
Organization
Contact information
Practice address
119 CANAL ST, STE 104, POOLER, GA 31322-4095
(912) 330-8444
(912) 330-8844
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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