Basic Information
| Provider Information | |||||||||
| NPI: | 1245863174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMORY PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102831 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303682831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042512007 | ||||||||
| FaxNumber: | 4043719112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042512007 | ||||||||
| FaxNumber: | 4043719112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2020 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2193656560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.