Provider Demographics
NPI:1629553284
Name:PACE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PACE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PACE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-898-9993
Mailing Address - Street 1:675 MILTON DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8500
Mailing Address - Country:US
Mailing Address - Phone:404-326-2854
Mailing Address - Fax:770-898-9983
Practice Address - Street 1:1617 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7311
Practice Address - Country:US
Practice Address - Phone:770-898-9993
Practice Address - Fax:770-898-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty