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General NPI Number Information
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NPI Number | 1356818652
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Entity Type | Organization
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Legal Business Name | EXCELARATE PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 216 HARRISON LN
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City | BRUNSWICK
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State | GA
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Zip | 31520-1959
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Country | US
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Telephone | 678-699-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 216 HARRISON LN
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City | BRUNSWICK
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State | GA
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Zip | 31520-1959
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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 - PHYSICAL THERAPIST
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Name | DR. SONYA DENISE ROLAND
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Credential |
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Telephone | 678-699-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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