Provider Demographics
NPI:1790517514
Name:PHYSICAL THERAPY & BALANCE LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY & BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-556-0031
Mailing Address - Street 1:1741 NEWNAN CROSSING BLVD E STE C
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6601
Mailing Address - Country:US
Mailing Address - Phone:470-627-7200
Mailing Address - Fax:
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E STE C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6601
Practice Address - Country:US
Practice Address - Phone:470-627-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty