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General NPI Number Information
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NPI Number | 1619456019
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Entity Type | Organization
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Legal Business Name | ATLANTA PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 338 HILLCREST AVE APT E
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City | DECATUR
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State | GA
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Zip | 30030-2068
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Country | US
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Telephone | 404-390-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 338 HILLCREST AVE APT E
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City | DECATUR
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State | GA
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Zip | 30030-2068
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Country | US
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Telephone | 404-390-0255
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. NICHOLAS VERNOLA JR.
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Credential | PT, DPT, SDN
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Telephone | 516-480-8434
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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 | PT012845
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License Number State | GA
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