Individual
JOHN THEOFILOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 686-3286
Mailing address
189 17TH ST NE, ATLANTA, GA 30309-3362
(404) 962-9696
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002781
GA
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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