Healthcare Provider Details

I. General information

NPI: 1487038675
Provider Name (Legal Business Name): ATLANTA PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 BUFORD HWY
CHAMBLEE GA
30341-3535
US

IV. Provider business mailing address

3401 JEFFERSON CIR S
CHAMBLEE GA
30341-2651
US

V. Phone/Fax

Practice location:
  • Phone: 775-230-9520
  • Fax:
Mailing address:
  • Phone: 775-230-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT011942
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TALIA JOYCE
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 775-230-9520