Healthcare Provider Details

I. General information

NPI: 1144505348
Provider Name (Legal Business Name): REBEKAH BROWN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH AVERSANO

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1020
ATLANTA GA
30308-2208
US

IV. Provider business mailing address

3747 PEACHTREE RD NE REHAB DEPT
ATLANTA GA
30319-1360
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-3467
  • Fax: 404-874-5858
Mailing address:
  • Phone: 404-233-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA002845
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: