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NPI Code Detail

MEDICARE: MATTIE GEREBEN PT, DPT

MEDICARE:   MATTIE  GEREBEN  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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1932769221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTIE GEREBEN PT, DPT
Provider Business Mailing Address
First Line : 1165 SANDERS RD
Second Line :
City : CUMMING
State : GA
Zip : 30041-5965
Country : US
Telephone Number : 470-533-4200
Fax Number :
Provider Business Practice Location Address
First Line : 1165 SANDERS RD
Second Line :
City : CUMMING
State : GA
Zip : 30041-5965
Country : US
Telephone Number : 704-533-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 02/25/2022

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Directions to “ MATTIE GEREBEN PT, DPT” Practice Location

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