Organization
BSTSA INC DBA SPECTRUM THERAPY CENTER
Active
Other names
Spectrum Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD LEE TUCKER (PRESIDENT)
(770) 609-6789
Entity
Organization
Contact information
Practice address
2346 WISTERIA DR, SNELLVILLE, GA 30078
(770) 609-6789
(678) 395-4901
Mailing address
1373 CHLOE DR, LAWRENCEVILLE, GA 30043-8383
(843) 655-3731
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
02/13/2019
Last updated
07/22/2020
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