Provider Demographics
NPI:1679093223
Name:GEORGIA PHYSICAL THERAPY & SPORTS MEDICINE CENTER
Entity Type:Organization
Organization Name:GEORGIA PHYSICAL THERAPY & SPORTS MEDICINE CENTER
Other - Org Name:GEORGIA PHYSICAL THERAPY & SPORTS MEDICINE CENTER - CUMMING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:770-888-3011
Mailing Address - Street 1:320 JESSICA WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5852
Mailing Address - Country:US
Mailing Address - Phone:678-383-6014
Mailing Address - Fax:770-234-6788
Practice Address - Street 1:2 TRI COUNTY PLZ
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2700
Practice Address - Country:US
Practice Address - Phone:770-888-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy