Provider Demographics
NPI:1083643449
Name:SIERRA THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:SIERRA THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUEENSTON
Authorized Official - Middle Name:U
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:770-465-5084
Mailing Address - Street 1:2155 WEST PARK COURT
Mailing Address - Street 2:SUITE G/ H
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-465-5084
Mailing Address - Fax:770-465-5304
Practice Address - Street 1:2155 W PARK CT
Practice Address - Street 2:SUITE G/ H
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3500
Practice Address - Country:US
Practice Address - Phone:770-465-5084
Practice Address - Fax:770-465-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3436Medicare ID - Type Unspecified