Provider Demographics
NPI:1295785434
Name:THE INSTITUTE FOR PHYSICAL THERAPY
Entity type:Organization
Organization Name:THE INSTITUTE FOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MCKINNIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:404-696-4449
Mailing Address - Street 1:550 FAIRBURN RD SW
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2014
Mailing Address - Country:US
Mailing Address - Phone:404-696-4449
Mailing Address - Fax:404-696-3422
Practice Address - Street 1:550 FAIRBURN RD SW
Practice Address - Street 2:SUITE B-1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2014
Practice Address - Country:US
Practice Address - Phone:404-696-4449
Practice Address - Fax:404-696-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007467261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicare ID - Type Unspecified