=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598710444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL MARWAHA PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2006
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 MOLLY LN STE 100
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30189-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-517-1080
-----------------------------------------------------
Fax | 302-998-7498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2910 HOLLY POINTE CT
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-6699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-220-0884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT010597
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------