Provider Demographics
NPI:1477888691
Name:METRO THERAPY PROVIDERS, INC ADULTS
Entity Type:Organization
Organization Name:METRO THERAPY PROVIDERS, INC ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-248-0415
Mailing Address - Street 1:3760 LAVISTA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5615
Mailing Address - Country:US
Mailing Address - Phone:404-248-0415
Mailing Address - Fax:404-248-0422
Practice Address - Street 1:3760 LAVISTA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5615
Practice Address - Country:US
Practice Address - Phone:404-248-0415
Practice Address - Fax:404-248-0422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO THERAPY PROVIDERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health