Provider Demographics
NPI:1679820484
Name:MARKOVICH, MICHAEL VILY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VILY
Last Name:MARKOVICH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BRIARHILL LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5421
Mailing Address - Country:US
Mailing Address - Phone:954-871-8900
Mailing Address - Fax:
Practice Address - Street 1:3945 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5252
Practice Address - Country:US
Practice Address - Phone:770-840-8046
Practice Address - Fax:770-840-8146
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist