Provider Demographics
NPI:1922236090
Name:THE CENTER FOR THE PHYSICALLY ACTIVE
Entity Type:Organization
Organization Name:THE CENTER FOR THE PHYSICALLY ACTIVE
Other - Org Name:THE CENTER FOR THE PHYSICALLY ACTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANTS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LAT
Authorized Official - Phone:678-418-0066
Mailing Address - Street 1:5000 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE B-13
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4085
Mailing Address - Country:US
Mailing Address - Phone:678-418-0066
Mailing Address - Fax:678-418-0122
Practice Address - Street 1:5000 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE B-13
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4085
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:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000392261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy