MEDICARE: ABOVE PHYSICAL THERAPY, LLC

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	PT006440	GA

General Provider Information

NPI Number	:	1972750503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE #330
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	770-904-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE #330
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	770-904-2332
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA-ELENA BOVE
Credential	:	MSPT
Telephone Number	:	770-904-2332

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	04/29/2011

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