Provider Demographics
NPI:1619037165
Name:CROSS MY HEART PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CROSS MY HEART PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-392-7110
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-0877
Mailing Address - Country:US
Mailing Address - Phone:404-392-7110
Mailing Address - Fax:
Practice Address - Street 1:1260 HIGHWAY 54 W
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4514
Practice Address - Country:US
Practice Address - Phone:404-392-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00267638OtherRAILROAD MEDICARE
GA52672107004OtherBLUE CROSS BLUE SHIELD
GAP00267638OtherRAILROAD MEDICARE
GA65 BBCVDMedicare ID - Type Unspecified