Provider Demographics
NPI:1588809107
Name:IVEY NEUROMUSCULAR LLC
Entity Type:Organization
Organization Name:IVEY NEUROMUSCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:770-565-6151
Mailing Address - Street 1:425 E CROSSVILLE RD
Mailing Address - Street 2:SUITE E111
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5817
Mailing Address - Country:US
Mailing Address - Phone:770-552-4218
Mailing Address - Fax:
Practice Address - Street 1:425 E CROSSVILLE RD
Practice Address - Street 2:SUITE E111
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5817
Practice Address - Country:US
Practice Address - Phone:770-552-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty