Provider Demographics
NPI:1043742281
Name:MILTON PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MILTON PHYSICAL THERAPY, LLC
Other - Org Name:CRABAPPLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-826-0440
Mailing Address - Street 1:1410 WOOD DUCK RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12220 BIRMINGHAM HWY
Practice Address - Street 2:BLDG10 / STE C
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4186
Practice Address - Country:US
Practice Address - Phone:770-826-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy