Healthcare Provider Details

I. General information

NPI: 1871929307
Provider Name (Legal Business Name): GAINESVILLE PHYSICAL THERAPY-CLAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N MAIN ST
CLAYTON GA
30525-4266
US

IV. Provider business mailing address

1296 SIMS ST SUITE A
GAINESVILLE GA
30501-3873
US

V. Phone/Fax

Practice location:
  • Phone: 770-297-1700
  • Fax: 770-297-1702
Mailing address:
  • Phone: 770-297-1700
  • Fax: 770-297-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: VICKI SIMS
Title or Position: OWNER/MANAGER
Credential: PT
Phone: 770-297-1700