Healthcare Provider Details

I. General information

NPI: 1336196948
Provider Name (Legal Business Name): BRAD STEPHEN FREEMYER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WOODSTOCK RD SUITE 310
ROSWELL GA
30075-2220
US

IV. Provider business mailing address

930 WOODSTOCK RD SUITE 310
ROSWELL GA
30075-2220
US

V. Phone/Fax

Practice location:
  • Phone: 770-998-6636
  • Fax: 770-998-6646
Mailing address:
  • Phone: 770-998-6636
  • Fax: 770-998-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT002661
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT002661
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT002661
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0002661
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: