Provider Demographics
NPI:1346049848
Name:PT AT HOME LLC
Entity type:Organization
Organization Name:PT AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:RIANNA
Authorized Official - Last Name:VANDER POL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, DPT
Authorized Official - Phone:770-540-2637
Mailing Address - Street 1:81 CROWN MOUNTAIN PL UNIT A300
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1619
Mailing Address - Country:US
Mailing Address - Phone:770-540-2637
Mailing Address - Fax:706-867-6859
Practice Address - Street 1:81 CROWN MOUNTAIN PL UNIT A300
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1619
Practice Address - Country:US
Practice Address - Phone:770-540-2637
Practice Address - Fax:706-867-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy