Provider Demographics
NPI:1275587628
Name:ALPHA SPORTS AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ALPHA SPORTS AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRESSINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-817-0197
Mailing Address - Street 1:10955 JONES BRIDGE RD
Mailing Address - Street 2:SUITE131
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8109
Mailing Address - Country:US
Mailing Address - Phone:770-817-0197
Mailing Address - Fax:770-817-0204
Practice Address - Street 1:10955 JONES BRIDGE RD
Practice Address - Street 2:SUITE131
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8109
Practice Address - Country:US
Practice Address - Phone:770-817-0197
Practice Address - Fax:770-817-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9329177OtherPHCS
GA9364279OtherPHCS
GA2279843OtherFIRST HEALTH
GA2279844OtherFIRST HEALTH
GAGRP6929Medicare ID - Type UnspecifiedMEDICARE PART B