| NPI | 1821367640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANN ALLYN JENNELLE Owner 678-431-7096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: GA PT008547) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA MT003325) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |