Healthcare Provider Details

I. General information

NPI: 1679191464
Provider Name (Legal Business Name): PT MAMAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5660 LAKE FORREST DR
ATLANTA GA
30342-4635
US

IV. Provider business mailing address

5660 LAKE FORREST DR
ATLANTA GA
30342-4635
US

V. Phone/Fax

Practice location:
  • Phone: 404-954-0883
  • Fax:
Mailing address:
  • Phone: 404-954-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIN EGGEBRECHT
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 404-558-6941