Organization
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COOK (OWNER)
(770) 207-6390
Entity
Organization
Contact information
Practice address
348 BIG A RD, TOCCOA, GA 30577
(770) 207-6390
Mailing address
1431 CAPITAL AVE, WATKINSVILLE, GA 30677-1883
(770) 207-6390
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5588
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000875102B
—
GA
Enumeration date
10/05/2015
Last updated
04/25/2024
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