MEDICARE: MR. LUIS RODOLFO CORDON MSPT

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	008290	GA

General Provider Information

NPI Number	:	1790013803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS RODOLFO CORDON MSPT

Provider Business Mailing Address
First Line	:	285 BOULEVARD NE
Second Line	:	SUITE 345
City	:	ATLANTA
State	:	GA
Zip	:	30312-4205
Country	:	US
Telephone Number	:	404-653-0039
Fax Number	:	404-653-0159

Provider Business Practice Location Address
First Line	:	285 BOULEVARD NE STE 610
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-4212
Country	:	US
Telephone Number	:	404-653-0039
Fax Number	:	404-653-0159

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

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	11/09/2020

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