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General NPI Number Information
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NPI Number | 1710322706
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Entity Type | Organization
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Legal Business Name | BIG GYM THERAPY, LLC
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 4005 CANTON RD
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City | MARIETTA
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State | GA
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Zip | 30066-2739
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Country | US
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Telephone | 770-728-8833
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Fax | 678-668-7469
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Provider Business Mailing Address
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Address Line | 4005 CANTON RD
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City | MARIETTA
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State | GA
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Zip | 30066-2739
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Country | US
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Telephone | 770-728-8833
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Fax | 678-668-7469
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Authorized Official
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Title or Position | MEMBER
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Name | RENEE ROBERTSON MADDUX
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Credential | P.T.
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Telephone | 678-736-0724
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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