Organization
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Active
Organization
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COOK PT (OWNER)
(770) 207-6390
Entity
Organization
Contact information
Practice address
1071 THOMAS AVE, WATKINSVILLE, GA 30677-6073
(770) 207-6390
(678) 374-4855
Mailing address
1431 CAPITAL AVE STE 123, WATKINSVILLE, GA 30677-1883
(706) 338-8058
(678) 374-4855
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5588
GA
225X00000X
Occupational Therapist
3287
GA
235Z00000X
Speech-Language Pathologist
5359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000875102B
—
GA
05
—
000964169E
—
GA
05
—
003130033A
—
GA
Enumeration date
08/05/2009
Last updated
04/25/2024
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