| NPI | 1205342730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNA CHERUKARA STANLEY Owner 770-634-4918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007245) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2017-12-20 |