Basic Information
| Provider Information | |||||||||
| NPI: | 1609445311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT SOLUTIONS OF ACWORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 CIRCLE 75 PKWY SE STE 1400 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789813543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3919 S HIGHWAY 14 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296156138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642529941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | PHILPOT | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR REV | ||||||||
| AuthorizedOfficialTelephone: | 6784033568 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.