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NPI Code Detail

MEDICARE: RUDO ALICE TAKAWIRA PT

MEDICARE: RUDO ALICE TAKAWIRA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical TherapistPT012671GA
2225100000XPhysical TherapistPT012671GA

General Provider Information

NPI Number : 1104331206
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUDO ALICE TAKAWIRA PT
Provider Business Mailing Address
First Line : 2376 BRANSLEY PL
Second Line :
City : DULUTH
State : GA
Zip : 30097-4336
Country : US
Telephone Number : 214-952-4605
Fax Number :
Provider Business Practice Location Address
First Line : 4595 CANTRELL RD
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3304
Country : US
Telephone Number : 770-967-2070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2017
Last Update Date : 03/29/2021

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Directions to “ RUDO ALICE TAKAWIRA PT” Practice Location

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