Provider Demographics
NPI:1962459883
Name:SPORTSCARE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SPORTSCARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-713-4363
Mailing Address - Street 1:4310 JOHNS CREEK PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6092
Mailing Address - Country:US
Mailing Address - Phone:770-495-0610
Mailing Address - Fax:770-495-0806
Practice Address - Street 1:4310 JOHNS CREEK PKWY STE 130
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6092
Practice Address - Country:US
Practice Address - Phone:770-495-0610
Practice Address - Fax:770-495-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002277225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty