Provider Demographics
NPI:1467980912
Name:LANIER THERAPY SOUTH, INC.
Entity Type:Organization
Organization Name:LANIER THERAPY SOUTH, INC.
Other - Org Name:LANIER THERAPY SOUTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARKFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:770-271-3458
Mailing Address - Street 1:5887 SPOUT SPRINGS RD STE D403
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3418
Mailing Address - Country:US
Mailing Address - Phone:770-967-9301
Mailing Address - Fax:770-967-9526
Practice Address - Street 1:5887 SPOUT SPRINGS RD STE D403
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3418
Practice Address - Country:US
Practice Address - Phone:770-967-9301
Practice Address - Fax:770-967-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0074762251X0800X, 261QP2000X
GAPT0110192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT007476OtherPHYSICAL THERAPY LICENSE
GAPT011019OtherPHYSICAL THERAPY LICENSE