Provider Demographics
NPI:1225790728
Name:FORGE PHYSICAL THERAPY & PERFORMANCE
Entity Type:Organization
Organization Name:FORGE PHYSICAL THERAPY & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-390-4111
Mailing Address - Street 1:6816 OMAHA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4185
Mailing Address - Country:US
Mailing Address - Phone:605-390-4111
Mailing Address - Fax:
Practice Address - Street 1:6816 OMAHA DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4185
Practice Address - Country:US
Practice Address - Phone:605-390-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty