Provider Demographics
NPI:1902830144
Name:OCONEE PHYSICAL THERAPY & SPORTS
Entity Type:Organization
Organization Name:OCONEE PHYSICAL THERAPY & SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:706-769-6261
Mailing Address - Street 1:1741 HOG MOUNTAIN RD
Mailing Address - Street 2:BLDG 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1947
Mailing Address - Country:US
Mailing Address - Phone:706-769-6261
Mailing Address - Fax:706-762-6316
Practice Address - Street 1:1741 HOG MOUNTAIN RD
Practice Address - Street 2:BLDG 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1947
Practice Address - Country:US
Practice Address - Phone:706-769-6261
Practice Address - Fax:706-762-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty