Healthcare Provider Details

I. General information

NPI: 1811725609
Provider Name (Legal Business Name): DAVID KWM VUE DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDSEY LN STE A
SAINT MARYS GA
31558-1727
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 912-729-1333
  • Fax: 912-729-5259
Mailing address:
  • Phone: 904-261-4414
  • Fax: 904-261-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42021
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017582
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: