Healthcare Provider Details

I. General information

NPI: 1437689288
Provider Name (Legal Business Name): DR. PEGGY MARBACH VESTIBULAR REHAB SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY ROAD BUILDING B-4, SUITE #100
SANDY SPRINGS GA
30328-6776
US

IV. Provider business mailing address

2474 REGENCY LAKE DR
MARIETTA GA
30062-8408
US

V. Phone/Fax

Practice location:
  • Phone: 770-522-9800
  • Fax:
Mailing address:
  • Phone: 770-378-8746
  • Fax: 770-522-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number000406
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number000406
License Number StateGA

VIII. Authorized Official

Name: PEGGY MARBACH
Title or Position: OWNER
Credential:
Phone: 770-522-9800