=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114106010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCPARS PHYSICAL THERAPY AND REHAB ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1810 MULKEY RD STE 101
-----------------------------------------------------
City | AUSTELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30106-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-443-4483
-----------------------------------------------------
Fax | 770-443-4410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1810 MULKEY RD STE 101
-----------------------------------------------------
City | AUSTELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30106-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-443-4483
-----------------------------------------------------
Fax | 770-443-4410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNT MANAGER
-----------------------------------------------------
Name | MONICA DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-443-4483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT002574
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------