Provider Demographics
NPI:1063912178
Name:PINNACLE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:VALIGORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:478-919-7442
Mailing Address - Street 1:789 HIGHWAY 96 STE 2B
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3357
Mailing Address - Country:US
Mailing Address - Phone:478-302-5111
Mailing Address - Fax:478-225-6453
Practice Address - Street 1:789 HIGHWAY 96 STE 2B
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3357
Practice Address - Country:US
Practice Address - Phone:478-302-5111
Practice Address - Fax:478-225-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010208261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy