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General NPI Number Information
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NPI Number | 1265029276
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Entity Type | Organization
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Legal Business Name | SPECIAL NEEDS IN MOTION
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1487 LACHONA CT NE
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City | ATLANTA
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State | GA
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Zip | 30329-3481
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Country | US
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Telephone | 404-989-4695
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Fax |
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Provider Business Mailing Address
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Address Line | 1487 LACHONA CT NE
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City | ATLANTA
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State | GA
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Zip | 30329-3481
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ILANA DANNEMAN
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Credential | PT
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Telephone | 404-989-4695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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