Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-8923
Entity
Organization
Contact information
Practice address
1453 RIVERSTONE PKWY, STE 170, CANTON, GA 30114-5626
(770) 704-0774
(770) 704-0779
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/06/2012
Last updated
05/10/2017
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