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General NPI Number Information
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NPI Number | 1942853916
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Entity Type | Organization
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Legal Business Name | CORE CARE WOMEN'S & CHILDREN'S WELLNESS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 1585 OLD NORCROSS RD STE 207B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4043
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Country | US
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Telephone | 404-487-8491
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 BRASELTON HWY STE 10-293
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City | DACULA
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State | GA
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Zip | 30019-3262
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Country | US
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Telephone | 404-487-8491
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Fax |
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Authorized Official
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Title or Position | OWNER/ DOCTOR OF PHYSICAL THERAPY
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Name | ESEOSA WALKER
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Credential | DPT
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Telephone | 404-487-8491
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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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