Healthcare Provider Details

I. General information

NPI: 1861790743
Provider Name (Legal Business Name): SAEROM PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 RIVER GREEN PKWY SUITE 110
DULUTH GA
30096-8336
US

IV. Provider business mailing address

1300 PEACHTREE INDUSTRIAL BLVD SUITE 2203
SUWANEE GA
30024-4539
US

V. Phone/Fax

Practice location:
  • Phone: 678-557-0600
  • Fax: 678-730-0229
Mailing address:
  • Phone: 678-557-0600
  • Fax: 678-730-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CONNIE JEON
Title or Position: OWNER
Credential: DPT
Phone: 678-557-0600