Provider Demographics
NPI:1548968860
Name:CONCIERGE PHYSICAL THERAPY OF THE CSRA, LLC
Entity type:Organization
Organization Name:CONCIERGE PHYSICAL THERAPY OF THE CSRA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUDENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:706-831-0793
Mailing Address - Street 1:3219 RAMSGATE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3215
Mailing Address - Country:US
Mailing Address - Phone:706-831-0793
Mailing Address - Fax:706-309-2814
Practice Address - Street 1:3219 RAMSGATE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3215
Practice Address - Country:US
Practice Address - Phone:706-831-0793
Practice Address - Fax:706-309-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000960593CMedicaid