# ACTIVEKIDZ AND ADULT THERAPY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093561656
- **Authorized official:** SUSAN GERALD COOK (OWNER)
- **Authorized official phone:** (770) 207-6390

## Contact information

- **Practice address:** 1130 SENOIA RD STE A1, TYRONE, GA 30290-1640
- **Practice address phone:** (678) 632-6765
- **Mailing address:** 1431 CAPITAL AVE STE 123, WATKINSVILLE, GA 30677-1883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | NULL | Yes |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/25/2024
- **Last updated:** 04/25/2024