MEDICARE: MATRIX REHABILITATION - GEORGIA, 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	:	1942231378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX REHABILITATION - GEORGIA, INC.

Provider Business Mailing Address
First Line	:	665 PHILADELPHIA ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3941
Country	:	US
Telephone Number	:	724-465-3496
Fax Number	:	724-465-3726

Provider Business Practice Location Address
First Line	:	4325 ATLANTA HWY
Second Line	:	SUITE 15
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3264
Country	:	US
Telephone Number	:	770-466-3100
Fax Number	:	770-466-3105

Authorized Official
Title or Position	:	CHEIF FINANCIAL OFFICER
Name	:	DENNIS J. FITZPATRICK
Credential	:
Telephone Number	:	610-644-7824

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/04/2008

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