Organization
INDEPENDENT PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVETTE E WALLACE (DIRECTOR OF CONTRACT MANAGEMENT)
(423) 238-7217
Entity
Organization
Contact information
Practice address
2295 TOWNE LAKE PKWY STE 148, WOODSTOCK, GA 30189-5520
(770) 926-2744
(770) 926-2794
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-7217
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
10/12/2012
Last updated
10/12/2012
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