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General NPI Number Information
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NPI Number | 1578975819
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Entity Type | Organization
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Legal Business Name | ATHLETES' POTENTIAL
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 1730 TAYLOR ST NW
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City | ATLANTA
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State | GA
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Zip | 30318-3742
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Country | US
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Telephone | 478-456-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 WOODLAND AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-2512
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Country | US
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Telephone | 478-456-2149
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. DANIEL MATTA
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Credential | PT, DPT, OCS, CSCS
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Telephone | 478-456-2149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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