Provider Demographics
NPI:1558815597
Name:TREASTER, MERCI ORTENZI (PT)
Entity Type:Individual
Prefix:
First Name:MERCI
Middle Name:ORTENZI
Last Name:TREASTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 PEACHTREE ST NE UNIT 1014
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1264
Mailing Address - Country:US
Mailing Address - Phone:770-757-0804
Mailing Address - Fax:
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:SUITE 712
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-907-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist