Provider Demographics
NPI:1619140753
Name:BUSINESS INTELLIGENCE TECHNOLOGY
Entity Type:Organization
Organization Name:BUSINESS INTELLIGENCE TECHNOLOGY
Other - Org Name:VELOCITY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:770-982-2103
Mailing Address - Street 1:335 MCKEES ROCK LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5005
Mailing Address - Country:US
Mailing Address - Phone:770-982-2103
Mailing Address - Fax:770-982-2103
Practice Address - Street 1:923 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-4537
Practice Address - Country:US
Practice Address - Phone:770-982-2103
Practice Address - Fax:770-760-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006109261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7110Medicare UPIN