Organization
ORTHOSPORT PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM E. CHASTAIN P.T. (FOUNDER AND CEO)
(770) 974-7494
Entity
Organization
Contact information
Practice address
3450 ACWORTH DUE WEST RD NW, SUITE 310, KENNESAW, GA 30144
(770) 974-7494
(770) 974-9141
Mailing address
3450 ACWORTH DUE WEST RD NW, SUITE 310, KENNESAW, GA 30144-1001
(770) 974-7494
(770) 974-9141
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3909
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
393730
BLUE CROSS BLUE SHIELD
GA
Enumeration date
01/09/2006
Last updated
02/07/2008
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