Healthcare Provider Details

I. General information

NPI: 1174367353
Provider Name (Legal Business Name): MARK LAPITAN OBANA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CHAPEL HILL RD STE 1200
DOUGLASVILLE GA
30135-1721
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 678-981-6290
  • Fax:
Mailing address:
  • Phone: 423-497-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13287
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: