Provider Demographics
NPI:1053338715
Name:NORTH VALDOSTA THERAPY SERVICES INC
Entity type:Organization
Organization Name:NORTH VALDOSTA THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HALMAN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:229-219-0700
Mailing Address - Street 1:4611 TILLMAN BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4965
Mailing Address - Country:US
Mailing Address - Phone:229-245-1048
Mailing Address - Fax:229-219-0702
Practice Address - Street 1:4611 TILLMAN BLUFF RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4965
Practice Address - Country:US
Practice Address - Phone:229-219-0700
Practice Address - Fax:229-219-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA195254462BMedicaid
GA195254462BMedicaid