Healthcare Provider Details

I. General information

NPI: 1972132603
Provider Name (Legal Business Name): BINGHAM ADULT THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 SATELLITE BLVD UNIT 957746
DULUTH GA
30095-0469
US

IV. Provider business mailing address

3628 SATELLITE BLVD UNIT 957746
DULUTH GA
30095-0469
US

V. Phone/Fax

Practice location:
  • Phone: 501-339-8282
  • Fax:
Mailing address:
  • Phone: 501-339-8282
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BINGHAM
Title or Position: MEMBER
Credential:
Phone: 501-339-8282