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General NPI Number Information
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NPI Number | 1336532613
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE THERAPY SERVICES LLS
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 50 SKIN ALLEY SUITE 4
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City | NORCROSS
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State | GA
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Zip | 30071
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Country | US
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Telephone | 678-404-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 50 SKIN ALLEY SUITE 4
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City | NORCROSS
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State | GA
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Zip | 30071
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Country | US
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Telephone | 678-404-7605
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT LANDON DIXON
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Credential | PT
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Telephone | 404-839-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 010554
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License Number State | GA
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