Provider Demographics
NPI:1144411893
Name:MASTER, PRITI ROOPAM (DPT)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:ROOPAM
Last Name:MASTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 WHITE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5801
Mailing Address - Country:US
Mailing Address - Phone:770-426-9945
Mailing Address - Fax:770-426-0641
Practice Address - Street 1:1431 WHITE CIR STE C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5801
Practice Address - Country:US
Practice Address - Phone:770-426-9945
Practice Address - Fax:770-426-0641
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist