Organization
ATLANTA SOUTH PHYSICAL THERAPY, INC
Active
Other names
Rehab South
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY BAGE (PRESIDENT)
(423) 238-7217
Entity
Organization
Contact information
Practice address
310 PHILIP BLVD, SUITE 102, LAWRENCEVILLE, GA 30045-8700
(678) 985-0238
(678) 985-0136
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD7784
RAILROAD MEDICARE GROUP PROVIDER #
GA
Enumeration date
05/17/2006
Last updated
04/29/2008
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