Healthcare Provider Details

I. General information

NPI: 1477482305
Provider Name (Legal Business Name): NEURO COMEBACK CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 COLBEN BLVD STE CANDD
EVANS GA
30809-6103
US

IV. Provider business mailing address

4104 COLBEN BLVD STE CANDD
EVANS GA
30809-6103
US

V. Phone/Fax

Practice location:
  • Phone: 301-233-4502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE SHORE
Title or Position: CO-OWNER
Credential: PT, DPT
Phone: 301-233-4502