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General NPI Number Information
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NPI Number | 1578925244
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Entity Type | Organization
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Legal Business Name | PARKVIEW PHYSICAL THERAPY AND REHAB LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 5615 OLD NATIONAL HWY SUITE D
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3811
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Country | US
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Telephone | 404-993-4275
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Fax |
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Provider Business Mailing Address
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Address Line | 5615 OLD NATIONAL HWY SUITE D
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City | COLLEGE PARK
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State | GA
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Zip | 30349-3811
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Country | US
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Telephone | 404-993-4275
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EKOP UDOFIA
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Credential |
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Telephone | 404-993-4275
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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 | PT010176
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License Number State | GA
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