Provider Demographics
NPI:1083875272
Name:BODYWELLNESS PHYSICAL THERAPY, L.L.C.
Entity Type:Organization
Organization Name:BODYWELLNESS PHYSICAL THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-593-6405
Mailing Address - Street 1:1364 ARNOLD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4634
Mailing Address - Country:US
Mailing Address - Phone:404-593-6405
Mailing Address - Fax:404-486-0286
Practice Address - Street 1:1364 ARNOLD AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4634
Practice Address - Country:US
Practice Address - Phone:404-593-6405
Practice Address - Fax:404-486-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007468261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy