Provider Demographics
NPI:1639659089
Name:MACIUBA, MARGARET JANE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:JANE
Last Name:MACIUBA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7568
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:2515 FENCE RD STE 160
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2138
Practice Address - Country:US
Practice Address - Phone:770-237-2852
Practice Address - Fax:770-237-2854
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10421225100000X
GAPT013557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist