Provider Demographics
NPI:1437916749
Name:SMART PHYSICAL THERAPY & WELLNESS LLC.
Entity Type:Organization
Organization Name:SMART PHYSICAL THERAPY & WELLNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-384-6520
Mailing Address - Street 1:2945 STONE HOGAN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2839
Mailing Address - Country:US
Mailing Address - Phone:229-471-7225
Mailing Address - Fax:
Practice Address - Street 1:2945 STONE HOGAN RD STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2839
Practice Address - Country:US
Practice Address - Phone:229-471-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty