Healthcare Provider Details

I. General information

NPI: 1477649002
Provider Name (Legal Business Name): ELEANORE E PURSER PT, MS, CERT. MDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W PACES FERRY RD NW STE 200
ATLANTA GA
30305-1366
US

IV. Provider business mailing address

107 W PACES FERRY RD NW STE 200
ATLANTA GA
30305-1366
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-9091
  • Fax:
Mailing address:
  • Phone: 404-783-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT009027
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0009027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: