MEDICARE: PHYSIO

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	012019	GA

General Provider Information

NPI Number	:	1801272273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIO

Provider Business Mailing Address
First Line	:	3605 BRASELTON HWY
Second Line	:	SUITE 101
City	:	DACULA
State	:	GA
Zip	:	30019-4666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 BRASELTON HWY
Second Line	:	SUITE 101
City	:	DACULA
State	:	GA
Zip	:	30019-4666
Country	:	US
Telephone Number	:	770-904-0772
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. DAVID WILLIAM NEWSOME JR.
Credential	:	DPT
Telephone Number	:	336-782-7461

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/07/2015

Similar Medicare Providers

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Practice Location Address:

3605 BRASELTON HWY STE 101
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30019-4666

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Practice Fax:

1942386073 — PHYSIOTHERAPY ASSOCIATES INC
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1063551950 — DR. MARY LU MCNEILL MD
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1174990295 — DAVID NEWSOME JR.
Practice Location Address:

3605 BRASELTON HWY STE 101
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1417801663 — JACLYN BULLUCK PT, DPT
Practice Location Address:

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1417802299 — HELEN UFUOMA IBIM
Practice Location Address:

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Directions to “PHYSIO ” Practice Location

Language	Start Address	Practice Location

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