Organization
PROFESSIONAL REHABILITATION ASSOCIATES, LLC
Active
Other names
Able Rehab of PRA, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COLLEEN GOODWIN OT (OWNER)
(770) 783-9797
Entity
Organization
Contact information
Practice address
2000 MIRROR LAKE BLVD STE T, VILLA RICA, GA 30180-2126
(770) 783-9797
Mailing address
2000 MIRROR LAKE BLVD STE T, VILLA RICA, GA 30180-2126
(770) 783-9797
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT001102
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67BBBGV
MEDICARE UNSPECIFIED
GA
Enumeration date
12/09/2013
Last updated
05/29/2014
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