MEDICARE: STEPHANIE S APPLEGATE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	GA007969	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GA007969	OTHER	GA	STATE LISC NUMBER

General Provider Information

NPI Number	:	1124107842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE S APPLEGATE PT

Provider Business Mailing Address
First Line	:	857 COLLIER RD
Second Line	:	SUITE 1
City	:	ATLANTA
State	:	GA
Zip	:	30318-2544
Country	:	US
Telephone Number	:	404-419-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 PHOENIX BLVD
Second Line	:	SUITE 205
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5588
Country	:	US
Telephone Number	:	770-907-1023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/24/2015

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Directions to “ STEPHANIE S APPLEGATE PT” Practice Location

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