Provider Demographics
NPI:1437228715
Name:MENSAH, NIA IRENE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:NIA
Middle Name:IRENE
Last Name:MENSAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NIA
Other - Middle Name:IRENE
Other - Last Name:TOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W. 141ST ST
Mailing Address - Street 2:#68
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:770-631-8277
Mailing Address - Fax:770-631-9403
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1020
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-874-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008840225100000X
NY02-9911-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008840OtherSTATE LISC NUMBER