Healthcare Provider Details

I. General information

NPI: 1073942603
Provider Name (Legal Business Name): PHYSICAL THERAPY PARTNERS OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 PALLADIAN VILLAGE DR SUITE 320
MARIETTA GA
30066-8200
US

IV. Provider business mailing address

3750 PALLADIAN VILLAGE DR SUITE 320
MARIETTA GA
30066-8200
US

V. Phone/Fax

Practice location:
  • Phone: 678-670-1289
  • Fax:
Mailing address:
  • Phone: 678-670-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT004824
License Number StateGA

VIII. Authorized Official

Name: BELVA-ANNE WELLMAN
Title or Position: OWNER
Credential: P.T.
Phone: 678-670-1289