MEDICARE: BRAD STEPHEN FREEMYER 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
1	2251G0304X	Geriatric Physical Therapist	PT002661	GA
2	2251S0007X	Sports Physical Therapist	PT002661	GA
3	2251X0800X	Orthopedic Physical Therapist	PT002661	GA
4	225100000X	Physical Therapist	PT0002661	GA

General Provider Information

NPI Number	:	1336196948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD STEPHEN FREEMYER PT

Provider Business Mailing Address
First Line	:	930 WOODSTOCK RD
Second Line	:	SUITE 310
City	:	ROSWELL
State	:	GA
Zip	:	30075-2220
Country	:	US
Telephone Number	:	770-998-6636
Fax Number	:	770-998-6646

Provider Business Practice Location Address
First Line	:	930 WOODSTOCK RD
Second Line	:	SUITE 310
City	:	ROSWELL
State	:	GA
Zip	:	30075-2220
Country	:	US
Telephone Number	:	770-998-6636
Fax Number	:	770-998-6646

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2024

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Directions to “ BRAD STEPHEN FREEMYER PT” Practice Location

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