Healthcare Provider Details

I. General information

NPI: 1134012453
Provider Name (Legal Business Name): ADVANCED RECOVERY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 ROSWELL RD
MARIETTA GA
30062-6236
US

IV. Provider business mailing address

3829 ROSWELL RD
MARIETTA GA
30062-6236
US

V. Phone/Fax

Practice location:
  • Phone: 770-321-0696
  • Fax:
Mailing address:
  • Phone: 770-321-0696
  • Fax: 405-603-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH KASKIE
Title or Position: OWNER
Credential:
Phone: 770-789-2225