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General NPI Number Information
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NPI Number | 1871929307
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Entity Type | Organization
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Legal Business Name | GAINESVILLE PHYSICAL THERAPY-CLAYTON
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 156 N MAIN ST
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City | CLAYTON
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State | GA
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Zip | 30525-4266
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Country | US
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Telephone | 770-297-1700
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Fax | 770-297-1702
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Provider Business Mailing Address
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Address Line | 1296 SIMS ST SUITE A
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City | GAINESVILLE
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State | GA
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Zip | 30501-3873
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Country | US
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Telephone | 770-297-1700
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Fax | 770-297-1702
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | VICKI SIMS
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Credential | PT
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Telephone | 770-297-1700
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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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