Basic Information
| Provider Information | |||||||||
| NPI: | 1114675188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT SOLUTIONS OF ACWORTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 CIRCLE 75 PKWY SE STE 1400 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789813543 | ||||||||
| FaxNumber: | 4047771311 | ||||||||
| Practice Location | |||||||||
| Address1: | 3152 PERIMETER PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309094583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785281362 | ||||||||
| FaxNumber: | 6785281368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2022 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | GAYLORD | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6789813543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.