Provider Demographics
NPI:1073942603
Name:PHYSICAL THERAPY PARTNERS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PARTNERS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELVA-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-670-1289
Mailing Address - Street 1:3750 PALLADIAN VILLAGE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8200
Mailing Address - Country:US
Mailing Address - Phone:678-670-1289
Mailing Address - Fax:
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8200
Practice Address - Country:US
Practice Address - Phone:678-670-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004824261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy