Healthcare Provider Details

I. General information

NPI: 1306278296
Provider Name (Legal Business Name): LAURA ROSE GOLD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 PEACHTREE RD NE #160
ATLANTA GA
30305-2430
US

IV. Provider business mailing address

3280 PEACHTREE RD NE #160
ATLANTA GA
30305-2430
US

V. Phone/Fax

Practice location:
  • Phone: 404-382-8667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: