Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MANAGER)
(423) 238-8923
Entity
Organization
Contact information
Practice address
2255 PEACHTREE RD NE, STE G, ATLANTA, GA 30309-1101
(404) 351-3257
(404) 351-3896
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
06/21/2012
Last updated
08/10/2012
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