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General NPI Number Information
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NPI Number | 1598049447
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Entity Type | Organization
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Legal Business Name | PROACTIVE REHAB, INC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 50 LAWRENCEVILLE STREET SUITE 100
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City | MCDONOUGH
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State | GA
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Zip | 30252
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Country | US
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Telephone | 770-320-7840
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LAWRENCEVILLE STREET SUITE 100
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City | MCDONOUGH
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State | GA
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Zip | 30252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JOSEPH POWELL
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Credential | PT
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Telephone | 770-320-7840
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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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