MEDICARE: SOUTHEAST REHABILITATION GROUP INC

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	:	1437855830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST REHABILITATION GROUP INC

Provider Business Mailing Address
First Line	:	4342 COLLINGHAM TRCE NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2705
Country	:	US
Telephone Number	:	404-578-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 MANSELL RD STE H
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4800
Country	:	US
Telephone Number	:	678-821-2170
Fax Number	:	678-821-2169

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ION TOMA
Credential	:
Telephone Number	:	404-578-0233

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	07/30/2023

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