Healthcare Provider Details

I. General information

NPI: 1942828595
Provider Name (Legal Business Name): CLASSIC CITY REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 TOWNS WALK DR
ATHENS GA
30606-7986
US

IV. Provider business mailing address

184 TOWNS WALK DR
ATHENS GA
30606-7986
US

V. Phone/Fax

Practice location:
  • Phone: 706-424-5921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NIDHI PATEL
Title or Position: CO-FOUNDER
Credential: PT, DPT, CERT-DN
Phone: 706-248-8706