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General NPI Number Information
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NPI Number | 1356785752
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Entity Type | Organization
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Legal Business Name | ALLSTAR PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 5615 OLD NATIONAL HWY STE D
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3817
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Country | US
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Telephone | 678-825-4190
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Fax | 678-368-4250
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Provider Business Mailing Address
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Address Line | 5615 OLD NATIONAL HWY STE D
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3817
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Country | US
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Telephone | 678-825-4190
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Fax | 678-368-4250
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Authorized Official
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Title or Position | OWNER
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Name | DR. EXOP UDOFIA
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Credential |
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Telephone | 678-825-4190
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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 |
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License Number State |
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