Provider Demographics
NPI:1710322706
Name:BIG GYM THERAPY, LLC
Entity Type:Organization
Organization Name:BIG GYM THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ROBERTSON
Authorized Official - Last Name:MADDUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-736-0724
Mailing Address - Street 1:325 WAVERLY HALL CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2110
Mailing Address - Country:US
Mailing Address - Phone:678-736-0724
Mailing Address - Fax:678-668-7469
Practice Address - Street 1:325 WAVERLY HALL CIR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2110
Practice Address - Country:US
Practice Address - Phone:678-736-0724
Practice Address - Fax:678-668-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty