Provider Demographics
NPI:1225990963
Name:ASCENSION PHYSICAL THERAPY AND PERFORMANCE INSTITUTE OF GEORGIA LLC
Entity type:Organization
Organization Name:ASCENSION PHYSICAL THERAPY AND PERFORMANCE INSTITUTE OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:706-604-4868
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-0251
Mailing Address - Country:US
Mailing Address - Phone:706-604-4868
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL STE N
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:706-604-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty