Provider Demographics
NPI:1518262682
Name:BRUBAKER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BRUBAKER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:678-763-0445
Mailing Address - Street 1:245 LODGE TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-7626
Mailing Address - Country:US
Mailing Address - Phone:678-763-0445
Mailing Address - Fax:770-716-0358
Practice Address - Street 1:245 LODGE TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-7626
Practice Address - Country:US
Practice Address - Phone:678-763-0445
Practice Address - Fax:770-716-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007154261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy