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General NPI Number Information
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NPI Number | 1568737849
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Entity Type | Organization
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Legal Business Name | MYOFASCIAL PHYSIOCARE LLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 2545 LAWRENCEVILLE HWY SUITE 100
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City | DECATUR
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State | GA
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Zip | 30033-3239
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Country | US
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Telephone | 404-377-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 LAWRENCEVILLE HWY SUITE 100
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City | DECATUR
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State | GA
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Zip | 30033-3239
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Country | US
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Telephone | 404-377-0011
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Fax |
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Authorized Official
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Title or Position | MANAGER/MEMEBER
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Name | DR. CARL HELDMAN
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Credential | DPT, FAAOMPT
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Telephone | 404-377-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 008128
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License Number State | GA
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