Organization
INDEPENDENT PHYSICAL THERAPY OF GA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHANNESON (VP REVENUE CYCLE)
(423) 238-2313
Entity
Organization
Contact information
Practice address
5948 E LAKE PKWY, MCDONOUGH, GA 30253-4802
(470) 878-6059
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-4915
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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