Healthcare Provider Details

I. General information

NPI: 1518998970
Provider Name (Legal Business Name): MATRIX REHABILITATION-GEORGIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date: 11/05/2007
Reactivation Date: 02/20/2008

III. Provider practice location address

9050 PERIODOT PARKWAY SUITE E
STOCKBRIDGE GA
30281-9417
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPARTMENT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-0540
  • Fax: 770-507-0506
Mailing address:
  • Phone: 717-972-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN F DUGGAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100