Organization
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Active
Other names
BenchMark Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY BAGE (PRESIDENT)
(423) 238-7217
Entity
Organization
Contact information
Practice address
2230 TOWNE LAKE PKWY, BUILDING 1200, SUITES 100 & 110, WOODSTOCK, GA 30189-5540
(770) 926-2744
(770) 926-2794
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
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK9205
RAILROAD MEDICARE GROUP PROVIDER #
GA
Enumeration date
05/17/2006
Last updated
06/25/2010
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