Provider Demographics
NPI:1639824568
Name:RECOVER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RECOVER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUITA
Authorized Official - Middle Name:CHARRISE
Authorized Official - Last Name:GATEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-314-3138
Mailing Address - Street 1:1787 BRISTOL FARMS CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2927
Mailing Address - Country:US
Mailing Address - Phone:678-314-3138
Mailing Address - Fax:
Practice Address - Street 1:1787 BRISTOL FARMS CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-2927
Practice Address - Country:US
Practice Address - Phone:678-314-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy