Provider Demographics
NPI:1760721179
Name:PEEWEE P.T., INC.
Entity Type:Organization
Organization Name:PEEWEE P.T., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:914-837-8297
Mailing Address - Street 1:880 MARIETTA HWY
Mailing Address - Street 2:SUITE 630-310
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6755
Mailing Address - Country:US
Mailing Address - Phone:914-837-8297
Mailing Address - Fax:770-643-3788
Practice Address - Street 1:880 MARIETTA HWY
Practice Address - Street 2:SUITE 630-310
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6755
Practice Address - Country:US
Practice Address - Phone:914-837-8297
Practice Address - Fax:770-643-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0089282251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty