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General NPI Number Information
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NPI Number | 1083875272
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Entity Type | Organization
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Legal Business Name | BODYWELLNESS PHYSICAL THERAPY, L.L.C.
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1364 ARNOLD AVE NE
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City | ATLANTA
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State | GA
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Zip | 30324-4634
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Country | US
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Telephone | 404-593-6405
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Fax | 404-486-0286
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Provider Business Mailing Address
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Address Line | 1364 ARNOLD AVE NE
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City | ATLANTA
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State | GA
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Zip | 30324-4634
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Country | US
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Telephone | 404-593-6405
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Fax | 404-486-0286
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Authorized Official
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Title or Position | CEO
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Name | AARON SMALL
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Credential | PT
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Telephone | 404-593-6405
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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 | PT007468
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License Number State | GA
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