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Organization
NEUROSPORT PHYSICAL THERAPY & REHABILITATION SPECIALIST INC.
Active
Organization
NEUROSPORT PHYSICAL THERAPY & REHABILITATION SPECIALIST INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MORIAH MORGAN (REGIONAL OFFICE MANAGER)
(770) 321-0155
Entity
Organization
Contact information
Practice address
1163 JOHNSON FERRY RD, STE 100, MARIETTA, GA 30068-2764
(770) 321-0155
(770) 321-8426
Mailing address
1163 JOHNSON FERRY RD, STE 100, MARIETTA, GA 30068-2764
(770) 321-0155
(770) 321-8426
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003709
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5093346
AETNA PPO, MC
—
01
—
52266108
BCBS OF GEORGIA
—
01
—
606717
AETNA HMO
—
01
—
650016944
RAILROAD MEDICARE
GA
Enumeration date
05/24/2005
Last updated
09/16/2014
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