Healthcare Provider Details

I. General information

NPI: 1245586908
Provider Name (Legal Business Name): MICHELLE MARIE CRAIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1020
ATLANTA GA
30308-2210
US

IV. Provider business mailing address

4060 PEACHTREE RD NE STE D-203
ATLANTA GA
30319-3020
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-3467
  • Fax:
Mailing address:
  • Phone: 323-804-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA002981
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: