MEDICARE: CANTON PHYSICAL MEDICARE, LLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1174831218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON PHYSICAL MEDICARE, LLC

Provider Business Mailing Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 CUMMING HWY
Second Line	:	SUITE 100
City	:	CANTON
State	:	GA
Zip	:	30114-8614
Country	:	US
Telephone Number	:	770-345-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN D PEYROUX
Credential	:
Telephone Number	:	770-345-9600

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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