Provider Demographics
NPI:1003868225
Name:INDEPENDENT PHYSICAL THERAPY OF GEORGIA , LLC
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY OF GEORGIA , LLC
Other - Org Name:BENCHMARK PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-536-7602
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 1:785 SHUGART RD STE 10
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2478
Practice Address - Country:US
Practice Address - Phone:706-226-0816
Practice Address - Fax:706-226-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-06-28
Deactivation Date:2006-12-21
Deactivation Code:
Reactivation Date:2008-05-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116848Medicare Oscar/Certification