Provider Demographics
NPI:1669862769
Name:WESTSIDE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:WESTSIDE PHYSICAL THERAPY, LLC
Other - Org Name:MOVEMENT SPORTS PHYSICAL THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-441-0206
Mailing Address - Street 1:2444 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3330
Mailing Address - Country:US
Mailing Address - Phone:404-382-8702
Mailing Address - Fax:404-492-7034
Practice Address - Street 1:1695 MARIETTA BLVD NW
Practice Address - Street 2:AT ATLANTA BALLET
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3644
Practice Address - Country:US
Practice Address - Phone:404-382-8702
Practice Address - Fax:404-492-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0084072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty