Provider Demographics
NPI:1174605307
Name:SOUTHERN THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN THERAPY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DME COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-845-9383
Mailing Address - Street 1:1805 VERNON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4041
Mailing Address - Country:US
Mailing Address - Phone:706-845-9383
Mailing Address - Fax:706-845-9482
Practice Address - Street 1:1805 VERNON RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4041
Practice Address - Country:US
Practice Address - Phone:706-845-9383
Practice Address - Fax:706-845-9482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN THERAPY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4492740002Medicare NSC