Healthcare Provider Details

I. General information

NPI: 1962727719
Provider Name (Legal Business Name): STABILITY PILATES AND PHYSICAL THERAPY OF ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 ROSWELL RD NE STE C-333
SANDY SPRINGS GA
30328-4048
US

IV. Provider business mailing address

5975 ROSWELL RD NE STE C-333
SANDY SPRINGS GA
30328-4048
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-9153
  • Fax: 770-451-8304
Mailing address:
  • Phone: 404-303-9153
  • Fax: 770-451-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6650
License Number StateGA

VIII. Authorized Official

Name: JESSICA LONCAR
Title or Position: OWNER
Credential: MS, PT, OCS, CERT MD
Phone: 404-303-9153