Provider Demographics
NPI:1629326178
Name:JOHNS CREEK THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:JOHNS CREEK THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-622-5440
Mailing Address - Street 1:4255 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6122
Mailing Address - Country:US
Mailing Address - Phone:770-622-5440
Mailing Address - Fax:770-622-5388
Practice Address - Street 1:4255 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6122
Practice Address - Country:US
Practice Address - Phone:770-622-5440
Practice Address - Fax:770-622-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006322261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)