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General NPI Number Information
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NPI Number | 1114561636
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Entity Type | Organization
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Legal Business Name | DRIVE PHYSICAL THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 700 HOLCOMB BRIDGE RD STE 200
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City | ROSWELL
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State | GA
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Zip | 30076-1630
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Country | US
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Telephone | 845-772-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 136 MILLSTONE WAY
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City | CANTON
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State | GA
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Zip | 30115-7270
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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/FOUNDER
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Name | ANDREW ZIS
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Credential | P.T, DPT
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Telephone | 845-772-1374
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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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