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General NPI Number Information
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NPI Number | 1679728463
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Entity Type | Organization
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Legal Business Name | PEACHTREE WOMEN'S PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 110 BASTILLE WAY SUITE 100A
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7620
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Country | US
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Telephone | 770-461-5270
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Fax |
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Provider Business Mailing Address
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Address Line | 105 ENGLEWOOD DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-3348
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Country | US
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Telephone | 770-461-5270
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTA BURNEY
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Credential |
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Telephone | 770-461-5270
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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 | 1439
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License Number State | GA
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