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General NPI Number Information
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NPI Number | 1851036057
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Entity Type | Organization
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Legal Business Name | FOUNDATION PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 619 EDGEWOOD AVE SE STE T101
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City | ATLANTA
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State | GA
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Zip | 30312-1987
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Country | US
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Telephone | 404-565-4064
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Fax | 678-550-9303
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Provider Business Mailing Address
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Address Line | 619 EDGEWOOD AVE SE STE T101
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City | ATLANTA
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State | GA
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Zip | 30312-1987
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Country | US
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Telephone | 404-565-4064
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Fax | 678-550-9303
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Authorized Official
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Title or Position | OWENR
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Name | DR. MATTHEW REGINALD MACLWOD
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Credential | DPT
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Telephone | 678-446-8269
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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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