# VAN VARICK PEDIATRIC PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1821464124
- **Authorized official:** ELIZABETH SAINT JOHN DPT (CFO)
- **Authorized official phone:** (561) 707-5209

## Contact information

- **Practice address:** 1000 HOLCOMB WOODS PKWY, SUITE 422, ROSWELL, GA 30076-2575
- **Practice address phone:** (770) 641-8070
- **Mailing address:** 1000 HOLCOMB WOODS PKWY, SUITE 422, ROSWELL, GA 30076-2575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT012056 | GA | — |
| 2251P0200X | Pediatric Physical Therapist | PT012056 | GA | Yes |

## Other

- **Enumeration date:** 08/20/2015
- **Last updated:** 08/20/2015