1346080827 NPI number — EMERGING BUTTERFLY THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346080827 NPI number — EMERGING BUTTERFLY THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGING BUTTERFLY THERAPY, LLC
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:
Provider Other Organization Name Type Code:
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:
1346080827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 CENTENNIAL OLYMPIC PARK DR NW UNIT 2508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30313-1973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-854-3607
Provider Business Mailing Address Fax Number:
404-393-8993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 CENTENNIAL OLYMPIC PARK DR NW UNIT 2508
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30313-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-854-3607
Provider Business Practice Location Address Fax Number:
404-393-8993
Provider Enumeration Date:
05/30/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NEWKIRK
Authorized Official First Name:
KRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
229-854-3607

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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