Organization
GROW WITH ME PEDIATRIC PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DIANE HIDALGO PT (PHYSICAL THERAPIST/PRESIDENT)
(678) 463-6621
Entity
Organization
Contact information
Practice address
310 PAPER TRAIL WAY, SUITE 302, CANTON, GA 30115-5203
(770) 345-2804
Mailing address
945 UMLAND RD, MARIETTA, GA 30066-5446
(678) 463-6621
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT007123
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000937087B
—
GA
Enumeration date
08/05/2008
Last updated
08/05/2008
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