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General NPI Number Information
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NPI Number | 1922587211
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Entity Type | Organization
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Legal Business Name | INSPIRED MOBILITY PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 4180 PROVIDENCE RD STE 107
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City | MARIETTA
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State | GA
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Zip | 30062-6187
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Country | US
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Telephone | 917-334-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 4557 WENDEN LN
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City | MARIETTA
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State | GA
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Zip | 30062-5696
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Country | US
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Telephone | 917-334-9108
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. JENNIFER KOPACH
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Credential | P.T.
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Telephone | 917-334-9108
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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 | PT010961
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License Number State | GA
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