Organization
PHYSICALLY EMPOWERED THERAPY & WELLNESS
Active
Other names
Tri-Cities Sports Medicine and Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEANCARLO ALENCASTRO ATC/L (CLINIC OWNER)
(770) 203-5144
Entity
Organization
Contact information
Practice address
2300 SUGARLEAF TRAIL, HAMPTON, GA 30228
(770) 203-5144
Mailing address
2300 SUGARLEAF TRAIL, HAMPTON, GA 30228
(770) 203-5144
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001665
GA
Other
Enumeration date
07/11/2011
Last updated
08/01/2018
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