Provider Demographics
NPI:1164741542
Name:HEALTHCORE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HEALTHCORE PHYSICAL THERAPY, LLC
Other - Org Name:PHYSICAL THERAPY AT THE CORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-763-7131
Mailing Address - Street 1:12030 ETRIS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1402
Mailing Address - Country:US
Mailing Address - Phone:770-998-6411
Mailing Address - Fax:770-998-6433
Practice Address - Street 1:12030 ETRIS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1402
Practice Address - Country:US
Practice Address - Phone:770-998-6411
Practice Address - Fax:770-998-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty