Healthcare Provider Details

I. General information

NPI: 1548448731
Provider Name (Legal Business Name): NEUROMUSCULAR ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2008
Last Update Date: 06/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CARPENTER DR NE SUITE 307
ATLANTA GA
30328-4928
US

IV. Provider business mailing address

4911 HERITAGE TRACE CT
MARIETTA GA
30062-6309
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-1053
  • Fax:
Mailing address:
  • Phone: 678-795-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT004390
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT004390
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License NumberMT004390
License Number StateGA

VIII. Authorized Official

Name: MS. SUSAN HUBENY
Title or Position: OFFICE MANAGER/THERAPIST
Credential:
Phone: 404-943-1053