Organization
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN COOK PT (OWNER)
(770) 207-6390
Entity
Organization
Contact information
Practice address
1247 TUSCANY DRIVE, SUITE C, BRASELTON, GA 30517-3402
(770) 207-6390
(678) 374-4855
Mailing address
1045 OLD MILL TRCE, MONROE, GA 30656-4379
(706) 338-8058
(678) 374-4855
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
TAX ID
GA
Enumeration date
07/09/2017
Last updated
10/30/2020
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