Provider Demographics
NPI:1477826121
Name:INTEGRATED PHYSICAL THERAPY & PERSONAL TRAINING, LLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY & PERSONAL TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-717-9113
Mailing Address - Street 1:251 RIVERBEND TRL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6042
Mailing Address - Country:US
Mailing Address - Phone:678-717-9113
Mailing Address - Fax:770-942-3053
Practice Address - Street 1:251 RIVERBEND TRL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6042
Practice Address - Country:US
Practice Address - Phone:678-717-9113
Practice Address - Fax:770-942-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty