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General NPI Number Information
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NPI Number | 1003020421
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Entity Type | Organization
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Legal Business Name | ALPHARETTA THERAPY SERVICES, LLC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 145 SABLE POINTE DR
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City | ALPHARETTA
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State | GA
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Zip | 30004-2773
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Country | US
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Telephone | 678-983-5304
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Fax | 770-667-9940
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Provider Business Mailing Address
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Address Line | 145 SABLE POINTE DR
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City | ALPHARETTA
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State | GA
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Zip | 30004-2773
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Country | US
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Telephone | 678-983-5304
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Fax | 770-667-9940
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. MIKE M. DIFRAKHSH
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Credential | MPT
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Telephone | 678-983-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT007856
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License Number State | GA
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