Provider Demographics
NPI:1831355601
Name:ARCHER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ARCHER PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, MLD/CDT
Authorized Official - Phone:423-693-5490
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-0031
Mailing Address - Country:US
Mailing Address - Phone:423-693-5490
Mailing Address - Fax:678-349-0693
Practice Address - Street 1:3012 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3782
Practice Address - Country:US
Practice Address - Phone:423-693-5490
Practice Address - Fax:678-349-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004654261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy