Provider Demographics
NPI:1083204275
Name:PEDIATRIC THERA PEA SERVICES OF GEORGIA, LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERA PEA SERVICES OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHILE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:706-344-9316
Mailing Address - Street 1:670 ARRENDALE RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-5128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 ARRENDALE RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-5128
Practice Address - Country:US
Practice Address - Phone:706-344-9316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty