Provider Demographics
NPI:1629758651
Name:STELLAR PHYSICAL THERAPY OF GEORGIA LLC
Entity Type:Organization
Organization Name:STELLAR PHYSICAL THERAPY OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-472-6564
Mailing Address - Street 1:4794 GLENBONNIE CT
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1610
Mailing Address - Country:US
Mailing Address - Phone:801-472-6564
Mailing Address - Fax:
Practice Address - Street 1:4794 GLENBONNIE CT
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30360-1610
Practice Address - Country:US
Practice Address - Phone:801-472-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy