Healthcare Provider Details

I. General information

NPI: 1720097561
Provider Name (Legal Business Name): EMORY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 HAWKS LN NE STE 160
BROOKHAVEN GA
30329-2283
US

IV. Provider business mailing address

8259 WICKER AVE
SAINT JOHN IN
46373-8878
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-2537
  • Fax: 404-251-2499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREG COOPER
Title or Position: MANAGING PARTNER
Credential:
Phone: 219-365-6560