MEDICARE: DOMINIQUE MAHARATH 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
1	225100000X	Physical Therapist	PT014238	GA

General Provider Information

NPI Number	:	1730735820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE MAHARATH PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	5815 WINDWARD PKWY STE 208
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4202
Country	:	US
Telephone Number	:	678-566-8091
Fax Number	:	678-566-8093

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	01/30/2020

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