MEDICARE: THE SPORTS REHABILITATION CENTER

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1154409381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPORTS REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	555 10TH STREET NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5713
Country	:	US
Telephone Number	:	404-477-8888
Fax Number	:	404-477-8889

Provider Business Practice Location Address
First Line	:	555 10TH STREET NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5713
Country	:	US
Telephone Number	:	404-477-8888
Fax Number	:	404-477-8889

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. DESTINY CARR
Credential	:
Telephone Number	:	404-477-8888

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/11/2013

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Directions to “THE SPORTS REHABILITATION CENTER ” Practice Location

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