Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Other names
Benchmark - Virginia Highlands
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MANAGER)
(423) 238-7217
Entity
Organization
Contact information
Practice address
842 N HIGHLAND AVE NE STE TER, ATLANTA, GA 30306-4530
(678) 685-9356
(678) 685-9357
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
07/05/2013
Last updated
07/05/2013
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