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General NPI Number Information
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NPI Number | 1134587074
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Entity Type | Organization
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Legal Business Name | FUNCTIONIZE HEALTH & PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/07/2016
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Last Update Date | 02/07/2016
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Provider Practice Location Address
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Address Line | 1199 SAINT ANDREWS CIR
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City | ATLANTA
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State | GA
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Zip | 30338-3201
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Country | US
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Telephone | 678-637-1497
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Fax | 678-587-5524
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Provider Business Mailing Address
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Address Line | 1199 SAINT ANDREWS CIR
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City | ATLANTA
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State | GA
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Zip | 30338-3201
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Country | US
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Telephone | 678-637-1497
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Fax | 678-587-5524
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | LAUREN SOK
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Credential | MPT
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Telephone | 678-637-1497
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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 | PT006885
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License Number State | GA
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