Provider Demographics
NPI:1437974250
Name:MAGNOLIA MOTION PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MAGNOLIA MOTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:706-654-8641
Mailing Address - Street 1:1242 HISTORIC HOMER HWY
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:GA
Mailing Address - Zip Code:30547-2737
Mailing Address - Country:US
Mailing Address - Phone:762-339-3600
Mailing Address - Fax:
Practice Address - Street 1:1242 HISTORIC HOMER HWY
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-2737
Practice Address - Country:US
Practice Address - Phone:762-339-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy