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General NPI Number Information
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NPI Number | 1528489853
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Entity Type | Organization
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Legal Business Name | REFORM PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 1705 MOUNT VERNON RD STE B
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City | ATLANTA
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State | GA
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Zip | 30338-4257
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Country | US
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Telephone | 404-445-7942
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 MOUNT VERNON RD STE B
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City | ATLANTA
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State | GA
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Zip | 30338-4257
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Country | US
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Telephone | 404-445-7942
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER - PHYSICAL THERAPIST
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Name | MISS MOLLY D PATEL
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Credential | DPT
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Telephone | 404-445-7942
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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 | 7689
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License Number State | GA
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