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General NPI Number Information
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NPI Number | 1265604896
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Entity Type | Organization
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Legal Business Name | GWINNETT SPORTHERAPY
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 965 OAKLAND RD STE 2C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3758
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Country | US
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Telephone | 770-962-2228
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Fax | 770-962-2332
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Provider Business Mailing Address
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Address Line | 965 OAKLAND RD STE 2C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3758
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Country | US
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Telephone | 770-962-2228
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Fax | 770-962-2332
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SONYA WEAVER WRIGHT
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Credential | MPT
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Telephone | 770-962-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT004490
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License Number State | GA
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