Provider Demographics
NPI:1942853916
Name:CORE CARE WOMEN'S & CHILDREN'S WELLNESS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CORE CARE WOMEN'S & CHILDREN'S WELLNESS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ESEOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-487-8491
Mailing Address - Street 1:2700 BRASELTON HWY STE 10-293
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3262
Mailing Address - Country:US
Mailing Address - Phone:404-487-8491
Mailing Address - Fax:
Practice Address - Street 1:1585 OLD NORCROSS RD STE 207B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4043
Practice Address - Country:US
Practice Address - Phone:404-487-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy