MEDICARE: PRITI ROOPAM MASTER DPT

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
1	225100000X	Physical Therapist	PT009176	GA

General Provider Information

NPI Number	:	1144411893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRITI ROOPAM MASTER DPT

Provider Business Mailing Address
First Line	:	1431 WHITE CIR STE C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5801
Country	:	US
Telephone Number	:	770-426-9945
Fax Number	:	770-426-0641

Provider Business Practice Location Address
First Line	:	1431 WHITE CIR STE C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5801
Country	:	US
Telephone Number	:	770-426-9945
Fax Number	:	770-426-0641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	04/20/2011

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Directions to “ PRITI ROOPAM MASTER DPT” Practice Location

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