Organization
SOMATIC PHYSICAL THERAPY LLC
Active
Other names
Somatic Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS J LONG PT, DPT, CMTPT (OWNER/PHYSICAL THERAPIST)
(920) 940-8350
Entity
Organization
Contact information
Practice address
210 SOUTH ST, CARROLLTON, GA 30117-3738
(470) 215-0862
Mailing address
1576 FOLKSTONE RD NE, BROOKHAVEN, GA 30329-1305
(920) 940-8350
(404) 393-4680
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18158
DRY NEEDLING CERTIFICATION, MYOPAIN 6-10-18
GA
01
—
PT009781
PT LICENSE NUMBER
GA
Enumeration date
02/18/2019
Last updated
02/18/2019
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