Healthcare Provider Details

I. General information

NPI: 1790325223
Provider Name (Legal Business Name): 3333 PT PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 OLD MILTON PKWY STE 180
ALPHARETTA GA
30005-0008
US

IV. Provider business mailing address

3333 OLD MILTON PKWY STE 180
ALPHARETTA GA
30005-0008
US

V. Phone/Fax

Practice location:
  • Phone: 770-401-6452
  • Fax:
Mailing address:
  • Phone: 770-401-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRONSON WALTERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-401-6452