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General NPI Number Information
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NPI Number | 1720600802
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Entity Type | Organization
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Legal Business Name | INTEGRAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1515 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30062-6492
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Country | US
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Telephone | 470-210-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 LANTERN COACH LN NE
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City | ROSWELL
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State | GA
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Zip | 30075-3195
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Country | US
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Telephone | 404-210-2093
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. LISA SHAW
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Credential | PT, DPT
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Telephone | 404-210-2093
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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 |
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License Number State |
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