Provider Demographics
NPI:1689936494
Name:ONECARE PHYSICAL THERAPYAND SPORTS MEDICINE
Entity Type:Organization
Organization Name:ONECARE PHYSICAL THERAPYAND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCANTS
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:678-418-0066
Mailing Address - Street 1:6146 COVINGTON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8395
Mailing Address - Country:US
Mailing Address - Phone:678-418-0066
Mailing Address - Fax:678-418-0122
Practice Address - Street 1:6146 COVINGTON HWY STE A
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8395
Practice Address - Country:US
Practice Address - Phone:678-418-0066
Practice Address - Fax:678-418-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000392172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty