Provider Demographics
NPI:1497995971
Name:PRO THERAPY SUPPLIES, LLC
Entity Type:Organization
Organization Name:PRO THERAPY SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:XUONG
Authorized Official - Middle Name:TIEN
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-441-9808
Mailing Address - Street 1:5201 BROOK HOLLOW PKWY STE J
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3640
Mailing Address - Country:US
Mailing Address - Phone:404-934-7955
Mailing Address - Fax:678-680-5818
Practice Address - Street 1:5201 BROOK HOLLOW PKWY STE J
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3640
Practice Address - Country:US
Practice Address - Phone:404-934-7955
Practice Address - Fax:678-680-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA303807993332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies