Healthcare Provider Details

I. General information

NPI: 1023607504
Provider Name (Legal Business Name): PETER HUANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 CHURCH ST
DECATUR GA
30030-1526
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-3710
  • Fax: 404-999-3712
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: