Organization
FUNCTIONAL VITALITY
Active
Parent organization
FUNCTIONAL VITALITY
Other names
Functional Vitality Home Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
FUNCTIONAL VITALITY
Authorized official
LATESS ECHAVARRIA OT (OWNER)
(470) 266-0623
Entity
Organization
Contact information
Practice address
680 GRANDVIEW RD, MANSFIELD, GA 30055-2571
(678) 278-8348
Mailing address
680 GRANDVIEW RD, MANSFIELD, GA 30055-2571
(470) 266-0623
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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