Provider Demographics
NPI:1437689288
Name:DR. PEGGY MARBACH VESTIBULAR REHAB SPECIALIST, LLC
Entity Type:Organization
Organization Name:DR. PEGGY MARBACH VESTIBULAR REHAB SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-522-9800
Mailing Address - Street 1:2474 REGENCY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8408
Mailing Address - Country:US
Mailing Address - Phone:770-378-8746
Mailing Address - Fax:770-522-9800
Practice Address - Street 1:6849 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:BUILDING B-4, SUITE #100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6776
Practice Address - Country:US
Practice Address - Phone:770-522-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000406225XP0019X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073048666OtherOCCUPATIONAL THERAPY