Provider Demographics
NPI:1629738026
Name:ENVERGA, ARNEL M
Entity Type:Individual
Prefix:MR
First Name:ARNEL
Middle Name:M
Last Name:ENVERGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-3594
Mailing Address - Country:US
Mailing Address - Phone:770-684-8388
Mailing Address - Fax:
Practice Address - Street 1:715 CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-3594
Practice Address - Country:US
Practice Address - Phone:770-684-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist