Provider Demographics
NPI:1457789927
Name:HIGHLAND PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:HIGHLAND PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:678-343-0084
Mailing Address - Street 1:4770 DESTITUTE WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3197
Mailing Address - Country:US
Mailing Address - Phone:678-343-0084
Mailing Address - Fax:678-943-8235
Practice Address - Street 1:4770 DESTITUTE WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-3197
Practice Address - Country:US
Practice Address - Phone:678-343-0084
Practice Address - Fax:678-943-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000805285BMedicaid