Organization
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COOK PT (OWNER)
(770) 207-6390
Entity
Organization
Contact information
Practice address
1045 OLD MILL TRCE, MONROE, GA 30656-4379
(770) 207-6390
(678) 374-4855
Mailing address
1431 CAPITAL AVE STE 123, WATKINSVILLE, GA 30677-1883
(770) 207-6390
(678) 374-4855
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5588
GA
225100000X
Physical Therapist
7510
GA
225X00000X
Occupational Therapist
4397
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008751002G
—
GA
05
—
000875102B
—
GA
05
—
210194080A
—
GA
05
—
619191397B
—
GA
Enumeration date
10/20/2006
Last updated
04/25/2024
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