Healthcare Provider Details

I. General information

NPI: 1215846803
Provider Name (Legal Business Name): TR PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 PEACHTREE INDUSTRIAL BLVD STE 800
DULUTH GA
30096-2630
US

IV. Provider business mailing address

205 ANNAHEY CIR
SUGAR HILL GA
30518-1193
US

V. Phone/Fax

Practice location:
  • Phone: 352-507-9362
  • Fax:
Mailing address:
  • Phone: 352-507-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINSUK SONG
Title or Position: MANAGING MEMBER
Credential: PT, DPT
Phone: 352-507-9362