Organization
1SOURCE FITNESS & SPORTS-NEURO REHAB LLC
Active
Other names
Onesource Sports Neuro Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLLIN ADU DPT.MBA.FAAOMPT (DR. OF PHYSICAL THERAPY)
(678) 257-4037
Entity
Organization
Contact information
Practice address
1670 MCKENDREE CHURCH RD STE 40, LAWRENCEVILLE, GA 30043-4100
(678) 257-4037
(678) 819-7536
Mailing address
1670 MCKENDREE CHURCH RD STE 40, LAWRENCEVILLE, GA 30043-4100
(678) 257-4037
(678) 819-7536
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT009750
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00319995A
—
GA
Enumeration date
01/19/2012
Last updated
03/20/2020
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