Healthcare Provider Details

I. General information

NPI: 1619664521
Provider Name (Legal Business Name): LIFTING LITTLES PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 GAVINWOOD PL
DECATUR GA
30033-3782
US

IV. Provider business mailing address

1165 GAVINWOOD PL
DECATUR GA
30033-3782
US

V. Phone/Fax

Practice location:
  • Phone: 760-504-9183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA SCHIRMER
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT, DPT, OCS
Phone: 760-504-9183