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General NPI Number Information
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NPI Number | 1184105405
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Entity Type | Organization
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Legal Business Name | PURE REHAB PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 06/11/2023
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Provider Practice Location Address
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Address Line | 840 KENNESAW AVE NW STE 2
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City | MARIETTA
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State | GA
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Zip | 30060-7928
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Country | US
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Telephone | 678-685-7270
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Fax | 678-503-2807
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Provider Business Mailing Address
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Address Line | 840 KENNESAW AVE NW STE 2
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City | MARIETTA
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State | GA
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Zip | 30060-7928
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Country | US
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Telephone | 678-685-7270
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Fax | 678-503-2807
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Authorized Official
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Title or Position | OWNER
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Name | AMY FARTHING
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Credential | DPT
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Telephone | 678-685-7270
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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 | 00076578
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License Number State | GA
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