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NPI Code Detail

MEDICARE: MARY CALDWELL DJIRE PT, DPT

MEDICARE: MARY CALDWELL DJIRE PT, 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
1225100000XPhysical Therapist13325TN
2225100000XPhysical TherapistPT013369GA

General Provider Information

NPI Number : 1285126441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CALDWELL DJIRE PT, DPT
Provider Business Mailing Address
First Line : 4477 PINERIDGE CIR
Second Line :
City : DUNWOODY
State : GA
Zip : 30338-6540
Country : US
Telephone Number : 706-271-8540
Fax Number :
Provider Business Practice Location Address
First Line : 3790 PLEASANT HILL RD STE 100
Second Line :
City : DULUTH
State : GA
Zip : 30096-5143
Country : US
Telephone Number : 770-497-4228
Fax Number : 770-497-4474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2018
Last Update Date : 05/04/2021

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Directions to “ MARY CALDWELL DJIRE PT, DPT” Practice Location

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