Organization
PR PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA L SAM DPT (OWNER)
(404) 680-2760
Entity
Organization
Contact information
Practice address
1558B HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4738
(404) 680-2760
Mailing address
131 KESWICK MANOR DR, TYRONE, GA 30290-1542
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2024
Last updated
01/23/2024
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