Provider Demographics
NPI:1205861143
Name:SOVEREIGN REHABILITATION OF CUMMING, LLC
Entity Type:Organization
Organization Name:SOVEREIGN REHABILITATION OF CUMMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MORAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-781-8851
Mailing Address - Street 1:5610 BETHELVIEW RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7522
Mailing Address - Country:US
Mailing Address - Phone:770-781-8851
Mailing Address - Fax:770-781-8227
Practice Address - Street 1:5610 BETHELVIEW RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7522
Practice Address - Country:US
Practice Address - Phone:770-781-8851
Practice Address - Fax:770-781-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty