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General NPI Number Information
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NPI Number | 1881076982
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Entity Type | Organization
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Legal Business Name | IN-HOME PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 1128 HARVEST BROOK DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4743
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Country | US
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Telephone | 770-601-8984
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Fax | 770-574-4428
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Provider Business Mailing Address
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Address Line | 1128 HARVEST BROOK DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4743
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Country | US
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Telephone | 770-601-8984
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Fax | 770-574-4428
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Authorized Official
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Title or Position | PT
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Name | MARIA SHEILA LAJA CAMPANANO
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Credential | DPT, WCC, CI
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Telephone | 770-601-8984
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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 | GA
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