Provider Demographics
NPI:1518999028
Name:PHYSICAL THERAPY PLUS, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PLUS, LLC
Other - Org Name:LAFAYETTE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-490-1295
Mailing Address - Street 1:120 W VILLANOW ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2463
Mailing Address - Country:US
Mailing Address - Phone:706-638-5983
Mailing Address - Fax:706-638-3612
Practice Address - Street 1:120 W VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2463
Practice Address - Country:US
Practice Address - Phone:706-638-5983
Practice Address - Fax:706-638-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005339225100000X
GA0068702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty