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General NPI Number Information
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NPI Number | 1679780092
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Entity Type | Organization
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Legal Business Name | MEDICAL & SPORTS REHABILITATION ASSOC. INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 2138 SCENIC HWY N
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City | SNELLVILLE
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State | GA
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Zip | 30078-6106
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Country | US
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Telephone | 770-979-1400
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Fax | 770-978-0974
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Provider Business Mailing Address
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Address Line | 2138 SCENIC HWY N
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City | SNELLVILLE
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State | GA
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Zip | 30078-6106
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Country | US
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Telephone | 770-979-1400
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Fax | 770-978-0974
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Authorized Official
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Title or Position | PT, OCS, MTC
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Name | DR. ROBERT EMERSON DUVALL
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Credential |
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Telephone | 770-979-1400
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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 | PT000978
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License Number State | GA
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