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General NPI Number Information
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NPI Number | 1043742281
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Entity Type | Organization
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Legal Business Name | MILTON PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 12220 BIRMINGHAM HWY BLDG10 / STE C
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City | MILTON
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State | GA
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Zip | 30004-4186
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Country | US
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Telephone | 770-826-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 WOOD DUCK RD
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City | WOODSTOCK
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State | GA
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Zip | 30188-4636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM CHASTAIN
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Credential | DPT
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Telephone | 770-826-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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