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General NPI Number Information
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NPI Number | 1861894743
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Entity Type | Individual
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Provider Name | JB CONCORDIO GALUTERA III PT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3921 OLD ATLANTA STATION DR SE
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City | ATLANTA
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State | GA
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Zip | 30339-1984
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Country | US
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Telephone | 850-766-1672
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 HOWELL MILL RD NW
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City | ATLANTA
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State | GA
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Zip | 30327-2108
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Country | US
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Telephone | 404-351-8410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT29656
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011738
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License Number State | GA
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