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General NPI Number Information
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NPI Number | 1699612846
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Entity Type | Organization
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Legal Business Name | OUTLAST SPORTS REHABILITATION, LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 330 RONNELL RD BLDG 300
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City | HOLLY SPRINGS
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State | GA
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Zip | 30115-8636
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Country | US
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Telephone | 404-308-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 330 RONNELL RD BLDG 300
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City | HOLLY SPRINGS
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State | GA
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Zip | 30115-8636
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Country | US
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Telephone | 404-308-0817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY EARNEST
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Credential | PT, DPT, CSCS
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Telephone | 404-308-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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