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General NPI Number Information
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NPI Number | 1386659894
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Entity Type | Organization
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Legal Business Name | PROMOTION PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 3890 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052-3917
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Country | US
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Telephone | 770-554-7977
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Fax | 770-554-4177
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Provider Business Mailing Address
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Address Line | 3890 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052-3917
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Country | US
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Telephone | 770-554-7977
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Fax | 770-554-4177
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | MRS. AMANDA G PILZ
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Credential | MPT
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Telephone | 770-554-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00677
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License Number State | GA
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