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General NPI Number Information
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NPI Number | 1366971277
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Entity Type | Organization
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Legal Business Name | PARK RIDGE HEALTHCARE AND PHYSICAL MEDICINE LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 2896 CHAMBLEE TUCKER ROAD SUITE 4
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City | ATLANTA
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State | GA
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Zip | 30341
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Country | US
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Telephone | 770-457-0584
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Fax | 770-457-0773
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Provider Business Mailing Address
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Address Line | 2896 CHAMBLEE TUCKER RD STE 2
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City | ATLANTA
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State | GA
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Zip | 30341-4009
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Country | US
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Telephone | 770-457-0584
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Fax | 770-457-0773
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK JOSEPH SALLARULO
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Credential | DC
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Telephone | 770-457-0584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR002472
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License Number State | GA
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