Provider Demographics
NPI:1477861904
Name:MERCER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MERCER PHYSICAL THERAPY
Other - Org Name:THE CORPORATION OF MERCER PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF MERCER MEDICINE
Authorized Official - Prefix:MS
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-301-2194
Mailing Address - Street 1:3001 MERCER UNIVERSITY DR
Mailing Address - Street 2:DAVIS BUILDING, SUITE 106
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4115
Mailing Address - Country:US
Mailing Address - Phone:678-547-6439
Mailing Address - Fax:678-547-6202
Practice Address - Street 1:3001 MERCER UNIVERSITY DR
Practice Address - Street 2:DAVIS BUILDING, SUITE 106
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4115
Practice Address - Country:US
Practice Address - Phone:678-547-6439
Practice Address - Fax:678-547-6202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CORPORATION OF MERCER UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-17
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0003086261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy