Provider Demographics
NPI:1407921489
Name:BUILDING BLOCKS PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:BUILDING BLOCKS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:404-202-5038
Mailing Address - Street 1:5167 WEATHERWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-1748
Mailing Address - Country:US
Mailing Address - Phone:404-202-5038
Mailing Address - Fax:
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:I-20
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:770-321-6705
Practice Address - Fax:770-321-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002561261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center