Provider Demographics
NPI:1912013608
Name:CARE REHABILITATION PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:CARE REHABILITATION PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:CARE REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SOUTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-229-5068
Mailing Address - Street 1:686 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4214
Mailing Address - Country:US
Mailing Address - Phone:770-229-5068
Mailing Address - Fax:770-228-8353
Practice Address - Street 1:686 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4214
Practice Address - Country:US
Practice Address - Phone:770-229-5068
Practice Address - Fax:770-228-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00802865AMedicaid
GA55003497AMedicaid
GA00802865AMedicaid