Healthcare Provider Details

I. General information

NPI: 1063343291
Provider Name (Legal Business Name): ROSELINE MATANMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 SANDY PLAINS RD
MARIETTA GA
30066-4721
US

IV. Provider business mailing address

558 PARLIAMENT ST
MARIETTA GA
30066-3683
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-7303
  • Fax: 770-973-7303
Mailing address:
  • Phone: 770-973-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: