Provider Demographics
NPI:1639686355
Name:INNOVATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-439-1934
Mailing Address - Street 1:3119 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1521
Mailing Address - Country:US
Mailing Address - Phone:678-439-1934
Mailing Address - Fax:844-728-8806
Practice Address - Street 1:3119 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1521
Practice Address - Country:US
Practice Address - Phone:678-439-1934
Practice Address - Fax:844-728-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty