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General NPI Number Information
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NPI Number | 1639824568
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Entity Type | Organization
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Legal Business Name | RECOVER PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 1787 BRISTOL FARMS CT
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City | GRAYSON
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State | GA
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Zip | 30017-2927
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Country | US
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Telephone | 678-314-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 1787 BRISTOL FARMS CT
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City | GRAYSON
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State | GA
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Zip | 30017-2927
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Country | US
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Telephone | 678-314-3138
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | SHAQUITA CHARRISE GATEWOOD
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Credential |
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Telephone | 678-314-3138
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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 |
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License Number State |
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