Healthcare Provider Details

I. General information

NPI: 1780187781
Provider Name (Legal Business Name): ATLANTA REHABILITATION AND PERFORMANCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 RONALD REAGAN BLVD STE 106
CUMMING GA
30041-7578
US

IV. Provider business mailing address

2400 WISTERIA DR STE A
SNELLVILLE GA
30078-2689
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-0502
  • Fax:
Mailing address:
  • Phone: 770-982-0102
  • Fax: 770-982-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN HAGYE
Title or Position: VP/OPERATIONS
Credential:
Phone: 770-982-0102