Provider Demographics
NPI:1194190686
Name:SAEROM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SAEROM PHYSICAL THERAPY
Other - Org Name:ALKALINE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MPH
Authorized Official - Phone:678-557-0600
Mailing Address - Street 1:6955 MCGINNIS FERRY RD STE 112
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3521
Mailing Address - Country:US
Mailing Address - Phone:678-335-5566
Mailing Address - Fax:678-335-5567
Practice Address - Street 1:6955 MCGINNIS FERRY RD STE 112
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3521
Practice Address - Country:US
Practice Address - Phone:678-335-5566
Practice Address - Fax:678-335-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty