Healthcare Provider Details

I. General information

NPI: 1851493068
Provider Name (Legal Business Name): BODY MECHANICS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-6394
US

IV. Provider business mailing address

1296 SIMS ST SUITE A
GAINESVILLE GA
30501-3850
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-9004
  • Fax:
Mailing address:
  • Phone: 770-297-1700
  • Fax: 770-297-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005
License Number StateGA

VIII. Authorized Official

Name: JEFFREY SKORPUT
Title or Position: DIRECTOR
Credential: PT
Phone: 770-297-1700