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General NPI Number Information
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NPI Number | 1710122791
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY FORUM
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 5755 NORTHPOINT PKWY SUITE 56
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City | ALPHARETTA
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State | GA
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Zip | 30022-1142
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Country | US
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Telephone | 678-431-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 5755 NORTHPOINT PKWY SUITE 56
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City | ALPHARETTA
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State | GA
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Zip | 30022-1142
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Country | US
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Telephone | 678-431-1301
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. AMITA GUPTA
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Credential | PT
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Telephone | 678-431-1301
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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 | PT005421
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License Number State | GA
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