Healthcare Provider Details

I. General information

NPI: 1891161352
Provider Name (Legal Business Name): PT SOLUTIONS OF ACWORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEVEN HILLS BLVD SUITE 105
DALLAS GA
30132-0574
US

IV. Provider business mailing address

PO BOX 441146
KENNESAW GA
30160-9522
US

V. Phone/Fax

Practice location:
  • Phone: 678-402-0515
  • Fax: 678-909-0673
Mailing address:
  • Phone: 770-917-1395
  • Fax: 770-423-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DALE M YAKE
Title or Position: CEO
Credential: DPT
Phone: 678-403-3560