Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Other names
BenchMark Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-7217
Entity
Organization
Contact information
Practice address
4404 HUGH HOWELL RD STE 18, TUCKER, GA 30084-4916
(770) 493-5543
(770) 493-5549
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
225XE1200X
Ergonomics Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK9205
RAILROAD MEDICARE PROVIDER #
GA
Enumeration date
05/17/2006
Last updated
09/20/2017
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