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General NPI Number Information
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NPI Number | 1164093803
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Entity Type | Organization
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Legal Business Name | FROM THE GROUND UP THERAPY AND WELLNESS
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Dates
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Enumeration Date | 07/04/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 2322 OSBORNE RD
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City | SAINT MARYS
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State | GA
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Zip | 31558-9189
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Country | US
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Telephone | 912-344-9644
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Fax |
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Provider Business Mailing Address
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Address Line | 468 THOROUGHBRED RD
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City | WOODBINE
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State | GA
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Zip | 31569-2679
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Country | US
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Telephone | 912-674-6640
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | HANNAH JOHNSON
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Credential | PT, DPT
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Telephone | 912-674-6640
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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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