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General NPI Number Information
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NPI Number | 1235771262
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Entity Type | Organization
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Legal Business Name | PURE PERSPECTIVE, LLC
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 684 GRAYSON PKWY
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City | GRAYSON
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State | GA
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Zip | 30017-1211
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Country | US
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Telephone | 678-480-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 RICE MILL CT
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City | GRAYSON
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State | GA
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Zip | 30017-4047
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Country | US
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Telephone | 678-480-5654
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFERY BRENT LITTLE
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Credential | OTR/L
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Telephone | 678-480-5654
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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