1487685772 NPI number — MATRIX REHABILITATION-GEORGIA INC

Table of content: (NPI 1487685772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487685772 NPI number — MATRIX REHABILITATION-GEORGIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATRIX REHABILITATION-GEORGIA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSIOTHERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487685772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-5245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-3496
Provider Business Mailing Address Fax Number:
215-413-4682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6329 ROSWELL RD NE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-255-4800
Provider Business Practice Location Address Fax Number:
404-255-4444
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POOL
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
FLECK
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
469-467-8705

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com