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General NPI Number Information
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NPI Number | 1326265877
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Entity Type | Organization
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Legal Business Name | PRO PERFORMANCE THERAPY, LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 4343 SHALLOWFORD RD STE 630
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City | MARIETTA
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State | GA
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Zip | 30062-5080
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Country | US
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Telephone | 770-449-5152
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Fax | 866-821-7683
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Provider Business Mailing Address
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Address Line | 4343 SHALLOWFORD RD STE 630
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City | MARIETTA
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State | GA
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Zip | 30062-5080
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Country | US
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Telephone | 770-449-5152
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Fax | 866-821-7683
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | AMANDA STILLINGS
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Credential |
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Telephone | 770-449-5152
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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 | PT007576
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License Number State | GA
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