Healthcare Provider Details

I. General information

NPI: 1508001116
Provider Name (Legal Business Name): PHYSIO-CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CASTLEBAR WAY
MCDONOUGH GA
30253-4786
US

IV. Provider business mailing address

605 CASTLEBAR WAY
MCDONOUGH GA
30253-4786
US

V. Phone/Fax

Practice location:
  • Phone: 678-523-8722
  • Fax: 678-583-0855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number6750
License Number StateGA

VIII. Authorized Official

Name: REMI DUROJAIYE
Title or Position: OWNER
Credential:
Phone: 678-523-8722