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General NPI Number Information
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NPI Number | 1649415217
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Entity Type | Organization
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Legal Business Name | LAKE OCONEE REHABILITATION AND PERFORMANCE CENTER, LLC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 117 HARMONY CROSSING SUITE 4
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City | EATONTON
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State | GA
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Zip | 31024
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Country | US
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Telephone | 706-454-1811
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Fax | 706-454-1812
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Provider Business Mailing Address
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Address Line | 117 HARMONY CROSSING SUITE 4
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City | EATONTON
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State | GA
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Zip | 31024
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Country | US
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Telephone | 706-454-1811
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Fax | 706-454-1812
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Authorized Official
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Title or Position | OWNER, PHYSICIAL THERAPIST
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Name | MR. BRIAN E PRELL
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Credential | P.T.
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Telephone | 706-454-1811
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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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