Healthcare Provider Details

I. General information

NPI: 1942231378
Provider Name (Legal Business Name): MATRIX REHABILITATION - GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 ATLANTA HWY SUITE 15
LOGANVILLE GA
30052-3264
US

IV. Provider business mailing address

665 PHILADELPHIA ST
INDIANA PA
15701-3941
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-3100
  • Fax: 770-466-3105
Mailing address:
  • Phone: 724-465-3496
  • Fax: 724-465-3726

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: DENNIS J. FITZPATRICK
Title or Position: CHEIF FINANCIAL OFFICER
Credential:
Phone: 610-644-7824