Healthcare Provider Details

I. General information

NPI: 1043125156
Provider Name (Legal Business Name): LIVE ABLE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 FORREST WALK
ROSWELL GA
30075-4023
US

IV. Provider business mailing address

2314 FORREST WALK
ROSWELL GA
30075-4023
US

V. Phone/Fax

Practice location:
  • Phone: 864-350-3525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY MORSE
Title or Position: OWNER
Credential:
Phone: 864-350-3525