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General NPI Number Information
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NPI Number | 1578519468
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY EAST LTD
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 2469 HERITAGE VLG SUITE 14
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City | SNELLVILLE
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State | GA
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Zip | 30078-6140
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Country | US
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Telephone | 604-754-9619
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Fax | 770-979-0395
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Provider Business Mailing Address
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Address Line | 2469 HERITAGE VLG SUITE 14
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City | SNELLVILLE
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State | GA
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Zip | 30078-6140
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Country | US
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Telephone | 604-754-9619
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Fax | 770-979-0395
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. FARRAH B AZORDEGAN
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Credential |
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Telephone | 604-754-9619
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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 | 2006OCC-0448
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License Number State | GA
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