Provider Demographics
NPI:1376111252
Name:CARDENAS, EMILY LIPSCOMB (PT, DPT, MBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LIPSCOMB
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7663
Mailing Address - Country:US
Mailing Address - Phone:561-504-1796
Mailing Address - Fax:
Practice Address - Street 1:5690 STATE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-6002
Practice Address - Country:US
Practice Address - Phone:770-814-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist