Physician Compare National (NPI:1568754794)

HEALTHCARE PROVIDER: COLLIN T ADU DPT.GCS.FAAOMPT. MBA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1568754794
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082878210
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120619000384
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADU
	Individual professional last name
Provider First Name	COLLIN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EMORY UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	1SOURCE FITNESS AND SPORTS-NEURO REHAB LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4183888316
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1670 MCKENDREE CHURCH RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 40
	Group Practice or individual's line 2 address
City	LAWRENCEVILLE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300434100
	Group Practice or individual's zip code (9 digits when available)
Phone Number	67825740371002
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y