Basic Information
| Provider Information | |||||||||
| NPI: | 1821760976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMORY PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102831 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303682831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042512007 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 ORTHO LN | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303292315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047786390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2193656560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | GRP6756 | 01 | GA | MEDICARE PTAN | OTHER |