Provider Demographics
NPI:1386659894
Name:PROMOTION PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PROMOTION PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PILZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:770-554-7977
Mailing Address - Street 1:3890 HIGHWAY 81 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3917
Mailing Address - Country:US
Mailing Address - Phone:770-554-7977
Mailing Address - Fax:770-554-4177
Practice Address - Street 1:3890 HIGHWAY 81 SOUTH
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3917
Practice Address - Country:US
Practice Address - Phone:770-554-7977
Practice Address - Fax:770-554-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBRGOtherMEDICARE PIN
GA821337OtherBLUE CROSS BLUE SHIELD
GADG3262OtherPALMETTO GBA
GA65BBBRGOtherMEDICARE PIN
GADG3262Medicare PIN