Organization
PROACTIVE PHYSICAL THERAPY AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE R WILSON (PT)
(706) 814-6887
Entity
Organization
Contact information
Practice address
2103 REEDALE AVE, AUGUSTA, GA 30906-3430
(706) 814-6887
(706) 814-6587
Mailing address
2103 REEDALE AVE, AUGUSTA, GA 30906-3430
(706) 814-6887
(706) 814-6587
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/01/2011
Last updated
07/18/2011
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