Organization
PROVENANCE REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER BUSBEE HUNT P.T. (OWNER)
(678) 570-9500
Entity
Organization
Contact information
Practice address
11975 MORRIS RD, SUITE 310, ALPHARETTA, GA 30005-4419
(678) 819-8720
(678) 819-8721
Mailing address
310 AURELIA TRCE, MILTON, GA 30004-4358
(678) 570-9500
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
20111729283
GA
Other
Enumeration date
07/28/2010
Last updated
06/02/2014
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