Provider Demographics
NPI:1114106010
Name:MCPARS PHYSICAL THERAPY AND REHAB ASSOCIATES PC
Entity Type:Organization
Organization Name:MCPARS PHYSICAL THERAPY AND REHAB ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-443-4483
Mailing Address - Street 1:1810 MULKEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1132
Mailing Address - Country:US
Mailing Address - Phone:770-443-4483
Mailing Address - Fax:770-443-4410
Practice Address - Street 1:1810 MULKEY RD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1132
Practice Address - Country:US
Practice Address - Phone:770-443-4483
Practice Address - Fax:770-443-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4790Medicare PIN