Provider Demographics
NPI:1679780092
Name:MEDICAL & SPORTS REHABILITATION ASSOC. INC
Entity Type:Organization
Organization Name:MEDICAL & SPORTS REHABILITATION ASSOC. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OCS, MTC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-979-1400
Mailing Address - Street 1:2138 SCENIC HWY N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6106
Mailing Address - Country:US
Mailing Address - Phone:770-979-1400
Mailing Address - Fax:770-978-0974
Practice Address - Street 1:2138 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6106
Practice Address - Country:US
Practice Address - Phone:770-979-1400
Practice Address - Fax:770-978-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000978261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP8088Medicare PIN