Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Other names
BenchMark
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MANAGER)
(423) 238-8923
Entity
Organization
Contact information
Practice address
4600 W VILLAGE PL SE STE 4007, SMYRNA, GA 30080-9213
(770) 438-2015
(770) 438-8536
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
05/30/2012
Last updated
06/05/2012
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