Provider Demographics
NPI:1558406397
Name:GAUDIO INC. DBA CHEROKEE PHYSIOTHERAPY
Entity Type:Organization
Organization Name:GAUDIO INC. DBA CHEROKEE PHYSIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT,CMDT
Authorized Official - Phone:770-924-3498
Mailing Address - Street 1:7914 HIGHWAY 92
Mailing Address - Street 2:100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5238
Mailing Address - Country:US
Mailing Address - Phone:770-924-3498
Mailing Address - Fax:770-924-3692
Practice Address - Street 1:7914 HIGHWAY 92
Practice Address - Street 2:100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5238
Practice Address - Country:US
Practice Address - Phone:770-924-3498
Practice Address - Fax:770-924-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002251 PT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00844951AMedicaid
GA00844951AMedicaid
GAS04375Medicare UPIN