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General NPI Number Information
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NPI Number | 1205027240
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 1657 DORSEY AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3378
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Country | US
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Telephone | 404-767-5842
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Fax | 404-767-5894
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Provider Business Mailing Address
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Address Line | 1657 DORSEY AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3378
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Country | US
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Telephone | 404-767-5842
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Fax | 404-767-5894
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JONATHAN EDWARD MATEY
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Credential | P.T.
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Telephone | 404-767-5842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 006449
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License Number State | GA
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