Provider Demographics
NPI:1578925244
Name:PARKVIEW PHYSICAL THERAPY AND REHAB LLC
Entity Type:Organization
Organization Name:PARKVIEW PHYSICAL THERAPY AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-993-4275
Mailing Address - Street 1:5615 OLD NATIONAL HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3811
Mailing Address - Country:US
Mailing Address - Phone:404-993-4275
Mailing Address - Fax:
Practice Address - Street 1:5615 OLD NATIONAL HWY
Practice Address - Street 2:SUITE D
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3811
Practice Address - Country:US
Practice Address - Phone:404-993-4275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010176261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy