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General NPI Number Information
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NPI Number | 1740355304
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Entity Type | Organization
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Legal Business Name | ATHLETIC SPINE REHABILITATION, LLC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 880 CANTON RD NE STE 100
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City | MARIETTA
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State | GA
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Zip | 30060-7283
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Country | US
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Telephone | 770-792-7522
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Fax | 770-792-7508
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Provider Business Mailing Address
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Address Line | 880 CANTON RD NE STE 100
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City | MARIETTA
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State | GA
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Zip | 30060-7283
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Country | US
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Telephone | 770-792-7522
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Fax | 770-792-7508
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Authorized Official
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Title or Position | OWNER
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Name | DR. HERBERT L SILVER
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Credential | PT, DSC, OCS
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Telephone | 770-792-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports 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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical 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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 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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