Healthcare Provider Details

I. General information

NPI: 1134587074
Provider Name (Legal Business Name): FUNCTIONIZE HEALTH & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2016
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 SAINT ANDREWS CIR
ATLANTA GA
30338-3201
US

IV. Provider business mailing address

1199 SAINT ANDREWS CIR
ATLANTA GA
30338-3201
US

V. Phone/Fax

Practice location:
  • Phone: 678-637-1497
  • Fax: 678-587-5524
Mailing address:
  • Phone: 678-637-1497
  • Fax: 678-587-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT006885
License Number StateGA

VIII. Authorized Official

Name: LAUREN SOK
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: MPT
Phone: 678-637-1497