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General NPI Number Information
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NPI Number | 1467984559
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Entity Type | Organization
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Legal Business Name | PROSPER PERFROMANCE & PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 560 OLD PEACHTREE RD NW SUITE 200
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City | SUWANEE
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State | GA
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Zip | 30024-7275
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Country | US
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Telephone | 478-987-9697
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Fax |
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Provider Business Mailing Address
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Address Line | 560 OLD PEACHTREE RD NW SUITE 200
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City | SUWANEE
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State | GA
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Zip | 30024-7275
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Country | US
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Telephone | 478-987-9697
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL OPERATIONS MANAGER
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Name | KRISTEN SPENCER
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Credential |
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Telephone | 478-987-9697
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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 | 008313
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License Number State | GA
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