MEDICARE: RESOLUTION WELLNESS

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	PT008592	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1013968890	OTHER	CA	NPI

General Provider Information

NPI Number	:	1679841324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOLUTION WELLNESS

Provider Business Mailing Address
First Line	:	10930 CRABAPPLE RD STE 16
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-5812
Country	:	US
Telephone Number	:	770-640-1116
Fax Number	:	866-813-0930

Provider Business Practice Location Address
First Line	:	10930 CRABAPPLE RD STE 16
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-5812
Country	:	US
Telephone Number	:	770-640-1116
Fax Number	:	866-813-0930

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL KILPATRICK
Credential	:
Telephone Number	:	770-640-1116

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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Directions to “RESOLUTION WELLNESS ” Practice Location

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