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NPI Code Detail

MEDICARE: PT MAMAS, LLC

MEDICARE: PT MAMAS, 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
12251P0200XPediatric Physical Therapist

General Provider Information

NPI Number : 1679191464
Entity Type Code : Organization
Provider Name (Legal Business Name) : PT MAMAS, LLC
Provider Business Mailing Address
First Line : 5660 LAKE FORREST DR
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4635
Country : US
Telephone Number : 404-954-0883
Fax Number :
Provider Business Practice Location Address
First Line : 5660 LAKE FORREST DR
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4635
Country : US
Telephone Number : 404-954-0883
Fax Number :
Authorized Official
Title or Position : PHYSICAL THERAPIST
Name : ERIN EGGEBRECHT
Credential : DPT
Telephone Number : 404-558-6941
Provider Enumeration Date : 07/08/2020
Last Update Date : 07/08/2020

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