Provider Demographics
NPI:1659552461
Name:HEALING ARTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HEALING ARTS PHYSICAL THERAPY
Other - Org Name:MONROE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:478-994-3390
Mailing Address - Street 1:120 N LEE ST STE E
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2122
Mailing Address - Country:US
Mailing Address - Phone:478-994-3390
Mailing Address - Fax:478-994-3389
Practice Address - Street 1:120 N LEE ST STE E
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-2122
Practice Address - Country:US
Practice Address - Phone:478-994-3390
Practice Address - Fax:478-994-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700327Medicare Oscar/Certification