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General NPI Number Information
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NPI Number | 1508105412
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Entity Type | Organization
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Legal Business Name | YOUR REHAB & PAIN CLINIC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 10820 ABBOTTS BRIDGE RD STE 240
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5783
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Country | US
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Telephone | 678-333-4528
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Fax |
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Provider Business Mailing Address
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Address Line | 10820 ABBOTTS BRIDGE RD STE 240
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5783
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Country | US
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Telephone | 678-333-4528
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JUNGSOO YOON
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Credential |
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Telephone | 678-333-4528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT003351
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License Number State | GA
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