Provider Demographics
NPI:1568950665
Name:TEAM 3 PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:TEAM 3 PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:413-214-4963
Mailing Address - Street 1:2101 SABLESHIRE WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6475
Mailing Address - Country:US
Mailing Address - Phone:413-214-4963
Mailing Address - Fax:
Practice Address - Street 1:1227 GREEN ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5409
Practice Address - Country:US
Practice Address - Phone:678-313-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0112382251X0800X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty