Provider Demographics
NPI:1992552764
Name:INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Entity type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PREET
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-914-8737
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:7201 TURNER LAKE RD NW STE 13
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2067
Practice Address - Country:US
Practice Address - Phone:470-444-1609
Practice Address - Fax:470-867-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty