Provider Demographics
NPI:1770073272
Name:OUR THERAPY PLACE, LLC
Entity type:Organization
Organization Name:OUR THERAPY PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:912-319-0399
Mailing Address - Street 1:402 STEPHANIE AVE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31236-9692
Mailing Address - Country:US
Mailing Address - Phone:757-685-9156
Mailing Address - Fax:912-785-2788
Practice Address - Street 1:402 STEPHANIE AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31236-9692
Practice Address - Country:US
Practice Address - Phone:757-685-9156
Practice Address - Fax:912-785-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT123292251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003186330AMedicaid