Provider Demographics
NPI:1477973261
Name:ASPIRE PEDIATRIC THERAPY OF GA, LLC
Entity Type:Organization
Organization Name:ASPIRE PEDIATRIC THERAPY OF GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BUREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-965-1861
Mailing Address - Street 1:7367 SPOUT SPRINGS RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5519
Mailing Address - Country:US
Mailing Address - Phone:770-965-1861
Mailing Address - Fax:770-965-1863
Practice Address - Street 1:7367 SPOUT SPRINGS RD
Practice Address - Street 2:SUITE 125
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5519
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:770-965-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP00398OtherGA SECRETARY OF STATE LICENSING BOARD