Provider Demographics
NPI:1407446602
Name:BARNES ORTHOPEDIC, SPORT, AND SPINE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BARNES ORTHOPEDIC, SPORT, AND SPINE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, OCS
Authorized Official - Phone:470-255-9325
Mailing Address - Street 1:3994 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4104
Mailing Address - Country:US
Mailing Address - Phone:470-507-4607
Mailing Address - Fax:470-507-4608
Practice Address - Street 1:3994 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-4104
Practice Address - Country:US
Practice Address - Phone:470-507-4607
Practice Address - Fax:470-507-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT015025OtherGEORGIA STATE BOARD OF PT