Provider Demographics
NPI:1356499115
Name:THERAPEDS, LLC
Entity Type:Organization
Organization Name:THERAPEDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-405-3451
Mailing Address - Street 1:P.O. BOX 1506
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233
Mailing Address - Country:US
Mailing Address - Phone:405-405-3451
Mailing Address - Fax:770-412-8576
Practice Address - Street 1:2395 HWY 36 E
Practice Address - Street 2:
Practice Address - City:MILNER
Practice Address - State:GA
Practice Address - Zip Code:30257
Practice Address - Country:US
Practice Address - Phone:404-405-3451
Practice Address - Fax:770-412-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0007821245AMedicaid
GA782871245AMedicaid