Provider Demographics
NPI:1437429933
Name:THERAPY CENTER NORTH INC
Entity Type:Organization
Organization Name:THERAPY CENTER NORTH INC
Other - Org Name:THERAPY CENTER EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-388-9249
Mailing Address - Street 1:2080 EASTSIDE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1953
Mailing Address - Country:US
Mailing Address - Phone:770-388-9249
Mailing Address - Fax:770-483-3350
Practice Address - Street 1:2080 EASTSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1953
Practice Address - Country:US
Practice Address - Phone:770-388-9249
Practice Address - Fax:770-483-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-31
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65BBBFVOtherGROUP PTAN
1811930506OtherNPI
202G709390OtherPTAN