Healthcare Provider Details

I. General information

NPI: 1558754895
Provider Name (Legal Business Name): NANCY COHEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TOWER RD NE STE 140
MARIETTA GA
30060-9412
US

IV. Provider business mailing address

6397 LEE HWY
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 770-419-9437
  • Fax:
Mailing address:
  • Phone: 423-238-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003258
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: