=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083151997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABLE PELVIC PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2017
-----------------------------------------------------
Last Update Date | 01/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MOUNT VERNON HWY NE SUITE 160
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-4295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-996-3225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1402 BILTMORE DR NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30329-3534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-996-3225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ADINA LEIFER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-996-3225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT012069
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------