| NPI | 1114221264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN M RUSSELL Owner/Physical Therapist 404-474-3211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: GA PT8561) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA PT8561) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2011-01-04 |