Healthcare Provider Details

I. General information

NPI: 1568584357
Provider Name (Legal Business Name): THIERRY URBAIN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

IV. Provider business mailing address

113 DAVIDSON DR
DALTON GA
30720-4012
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-5533
  • Fax: 706-428-0033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3733
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: