=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699905554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDY SPRINGS PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2009
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5290 ROSWELL RD SUITE W
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-477-5555
-----------------------------------------------------
Fax | 404-477-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5290 ROSWELL RD STE #W
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-477-5555
-----------------------------------------------------
Fax | 404-477-5556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JASON REISS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-477-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------