Healthcare Provider Details

I. General information

NPI: 1093426264
Provider Name (Legal Business Name): BEYOND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 GLENWOOD RD
DECATUR GA
30032-4274
US

IV. Provider business mailing address

3312 GLENWOOD RD
DECATUR GA
30032-4274
US

V. Phone/Fax

Practice location:
  • Phone: 678-465-7083
  • Fax: 678-716-6870
Mailing address:
  • Phone: 678-465-7083
  • Fax: 678-716-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ANGLIN
Title or Position: OWNER
Credential: PTA
Phone: 678-754-1375