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Organization
BSTSA INC DBA SPECTRUM THERAPY CENTER
Active
Organization
BSTSA INC DBA SPECTRUM THERAPY CENTER
Active
Other names
Spectrum Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD LEE TUCKER (PRESIDENT)
(770) 609-6789
Entity
Organization
Contact information
Practice address
2346 WISTERIA DR, SNELLVILLE, GA 30078
(770) 609-6789
(678) 395-4901
Mailing address
1373 CHLOE DR, LAWRENCEVILLE, GA 30043-8383
(843) 655-3731
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
02/13/2019
Last updated
07/22/2020
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