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General NPI Number Information
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NPI Number | 1417735960
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Entity Type | Organization
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Legal Business Name | ONESOURCE OSTEOPRACTIC REHAB
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 367 ATHENS HWY STE 1100
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City | LOGANVILLE
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State | GA
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Zip | 30052-8256
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Country | US
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Telephone | 678-250-4035
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Fax |
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Provider Business Mailing Address
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Address Line | 367 ATHENS HWY STE 1100
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City | LOGANVILLE
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State | GA
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Zip | 30052-8256
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Country | US
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Telephone | 678-250-4037
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | COLLIN ADU
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Credential | DPT
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Telephone | 678-548-0879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology 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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 225X00000X
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Taxonomy Name | Occupational 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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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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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