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General NPI Number Information
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NPI Number | 1508053364
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Entity Type | Organization
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Legal Business Name | WEST SIDE MEDICAL AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 4780 ASHFORD DUNWOODY RD SUITE A-617
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City | ATLANTA
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State | GA
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Zip | 30338-5564
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Country | US
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Telephone | 866-592-9432
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 ASHFORD DUNWOODY RD SUITE A-617
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City | ATLANTA
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State | GA
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Zip | 30338-5564
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Country | US
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Telephone | 866-592-9432
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CARL T SHENKMAN
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Credential |
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Telephone | 866-592-9432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036000
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License Number State | GA
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